Information Collection

Uncompensated Services Reporting And Recordkeeping, 42 Cfr 124 Subpart F

IC 110246 under ICR 199010-0915-002 · OMB 0915-0077.

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Information Collection (IC) Details

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IC Title:	UNCOMPENSATED SERVICES REPORTING AND RECORDKEEPING, 42 CFR 124 SUBPART F	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	HRSA-710				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,856	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	348,799	335,652	9,106	4,041
Annual IC Time Burden (Hours)	995,087	-637,565	-17,296	1,649,948
Annual IC Cost Burden (Dollars)	0	0	0	0

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