Information Collection

283 Master, 285 DHS CIS eVfy, 286 HHS ONC, 287 CQs

IC 191492 under ICR 200905-1090-001 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 285 eVfy 285 DHS CIS eVerify Questionnaire 283 Master, 285 DHS CIS eVfy, 286 HHS ONC, 287 CQs	Form
Form 283 Master 283 Master Questions List as of 11-17-09 283 Master, 285 DHS CIS eVfy, 286 HHS ONC, 287 CQs	Form
Form 286 HHS ONC 286 HHS ONC Questions 283 Master, 285 DHS CIS eVfy, 286 HHS ONC, 287 CQs	Form
Form 287 Custom 287 Custom Questions from 11-16-09 to 12-4-09 283 Master, 285 DHS CIS eVfy, 286 HHS ONC, 287 CQs	Form
285 eVfy 285 DHS CIS eVerify Questionnaire 285 DHS CIS eVerify Questionnaire FINAL 12-4-09.xls	Form
283 Master 283 Master Questions List as of 11-17-09 283 Master Questions List as of 11-17-09.xls	Form
286 HHS ONC 286 HHS ONC Questions 286 HHS ONC_Questions_FINAL 12-4-09.xls	Form
287 Custom 287 Custom Questions from 11-16-09 to 12-4-09 287 Custom Questions for OMB 11-16-09 to 12-4-09.xls	Form

IC Title:

283 Master, 285 DHS CIS eVfy, 286 HHS ONC, 287 CQs

Agency IC Tracking Number:

283, Master, 285 eVfy, 286 HHS ONC, 287 CQs

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	285 eVfy	Yes	Yes	Fillable Fileable
Form	283 Master	Yes	Yes	Fillable Fileable
Form	286 HHS ONC	Yes	Yes	Fillable Fileable
Form	287 Custom	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	833	833
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].