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1995 Short-term, General, and Other Special Hospital Civil Rights Compliance Report and Hill-Burton Community Service Assurance Report for Triennial V
1995 Short-term, General, and Other Special Hospital Civil Rights Compliance Report and Hill-Burton Community Service Assurance Report for Triennial V
OMB: 0990-0209
IC ID: 116778
OMB.report
HHS/HHSDM
OMB 0990-0209
ICR 199506-0990-001
IC 116778
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
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IC Title:
1995 Short-term, General, and Other Special Hospital Civil Rights Compliance Report and Hill-Burton Community Service Assurance Report for Triennial V
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
503
Yes
Yes
Form
541
Yes
Yes
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
4,975
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
1 %
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
1,659
0
1,659
0
0
0
Annual IC Time Burden (Hours)
53,918
0
53,918
0
0
0
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.