Uncompensated Services Assurance Report

Uncompensated Services Assurance Report

OMB: 0915-0077

IC ID: 6349

Information Collection (IC) Details

View Information Collection (IC)

Uncompensated Services Assurance Report
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 710 Uncompensated Services Assurance Report HRSAForm710.pdf ftp://ftp.hrsa.gov/hillburton/servassure.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

223 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 8,873 0 0 -20,335 0 29,208
Annual IC Time Burden (Hours) 14,679 0 0 -18,361 0 33,040
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Authorizing legislation-PHS Act AuthorizingLegislation-0077.pdf 04/13/2009
Current Regulations-0077 CurrentRegulations-0077.pdf 04/13/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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