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Hill-burton Community Service Assurance Report Triennial Iv
HILL-BURTON COMMUNITY SERVICE ASSURANCE REPORT TRIENNIAL IV
OMB: 0990-0096
IC ID: 116598
OMB.report
HHS/HHSDM
OMB 0990-0096
ICR 199206-0990-001
IC 116598
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0096 can be found here:
1995-03-27 - Extension without change of a currently approved collection
1993-09-23 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
(TRIENNIAL
No
No
Form
II)
No
No
Form
OS/OCR-541
No
No
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,100
0
0
0
0
2,100
Annual IC Time Burden (Hours)
110,250
0
0
0
0
110,250
Annual IC Cost Burden (Dollars)
0
0
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.