Information Collection

1995 Short-term, General, and Other Special Hospital Civil Rights Compliance Report and Hill-Burton Community Service Assurance Report for Triennial V

IC 116778 under ICR 199506-0990-001 · OMB 0990-0209.

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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:

table that charts list of 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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,659	1,659
Annual IC Time Burden (Hours)	53,918	53,918
Annual IC Cost Burden (Dollars)	0	0

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