Information Collection

Revised Resource Organization Questionnaire (Fifth Version)

IC 6708 under ICR 200702-0920-005 · OMB 0920-0255.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0255 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Revised Resource Organization Questionnaire (Fifth Version)	Form and Instruction
Appendix C Revised Resource Organization Questionnaire ( Revised Resource Organization Questionniare (Fifth Version.doc	Form and Instruction

IC Title:

Revised Resource Organization Questionnaire (Fifth Version)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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 and Instruction	None	Appendix C Revised Resource Organization Questionnaire (Fifth Version)	Revised Resource Organization Questionniare (Fifth Version.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 40 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,000	867	19,133
Annual IC Time Burden (Hours)	5,667	1,809	3,858
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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