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Individuals Screened
Facts for Consumers About Health
OMB: 0990-0347
IC ID: 189373
OMB.report
HHS/HHSDM
OMB 0990-0347
ICR 200905-0990-001
IC 189373
( )
Documents and Forms
Document Name
Document Type
0990-Facts for Consumers Statement-attahment.doc
Other-Moderator Guide
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Individuals Screened
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Moderator Guide
0990-Facts for Consumers Statement-attahment.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
84
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
84
0
84
0
0
0
Annual IC Time Burden (Hours)
21
0
21
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
