Information Collection

Uncompensated Services Reporting And Recordkeeping, 42 Cfr 124 Subpart F

IC 165566 under ICR 199106-0915-004 · 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	Previously Approved
Annual Number of Responses for this IC	348,799	348,799
Annual IC Time Burden (Hours)	995,087	995,087
Annual IC Cost Burden (Dollars)	0	0

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