Information Collection

Web Survey

IC 187338 under ICR 200811-0990-002 · OMB 0990-0336.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990 Web Survey	Form
0990 Web Survey 0990-EvaluInstitutionResearchFinal Form for OMB.doc	Form

IC Title:

Web Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	0990	Web Survey	0990-EvaluInstitutionResearchFinal Form for OMB.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,754

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,754	10,754
Annual IC Time Burden (Hours)	3,585	3,585
Annual IC Cost Burden (Dollars)	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.