Information Collection

Provider Questionnaire

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

3906

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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	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 %

table that charts list of burden
	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

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.