Information Collection

Federal Agency Retail Pharmacy Program

IC 5612 under ICR 200511-0720-003 · OMB 0720-0032.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0032 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Federal Agency Retail Pharmacy Program	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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,000	800	1,200
Annual IC Time Burden (Hours)	16,000	6,400	9,600
Annual IC Cost Burden (Dollars)	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.