Information Collection

Provider Questionnaire

IC 187940 under ICR 200902-1875-002 · OMB 1875-0216.

Documents and Forms

Document Name Document Type
Provider Questionnaire Form
Provider Questionnaire Att_Appendix A (3 of 4) - Provider Qx for 2nd OMB (01-23-09).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Provider Questionnaire	Agency IC Tracking Number:	3906

Is this a Common Form? No		IC Status: New

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
Form	N/A	Provider Questionnaire	Att_Appendix A (3 of 4) - Provider Qx for 2nd OMB (01-23-09).pdf		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 85 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.