Information Collection

Hill-burton Community Service Assurance Report Triennial Iv

IC 116597 under ICR 198906-0990-001 · OMB 0990-0096.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0096 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	HILL-BURTON COMMUNITY SERVICE ASSURANCE REPORT TRIENNIAL IV	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.	Available Electronically?	Can Be Submitted Electronically?
Form	(TRIENNIAL	No	No
Form	OS/OCR-541	No	No
Form	II)	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,300	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,100	-33	-34	2,167
Annual IC Time Burden (Hours)	110,250	-3,570	-3,631	117,451
Annual IC Cost Burden (Dollars)	0	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.