Bureau Of Community Health Services Common Reporting Requirements

BUREAU OF COMMUNITY HEALTH SERVICES COMMON REPORTING REQUIREMENTS

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0004 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	BUREAU OF COMMUNITY HEALTH SERVICES COMMON REPORTING REQUIREMENTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HSA-350				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,200	-1,744	3,944
Annual IC Time Burden (Hours)	52,800	-81,296	134,096
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.