OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Full Application Required Data Elements

IC 190467 under ICR 200908-0990-006 · OMB 0990-0343.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Full Application Required Data Elements
 
  New
 
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 1 Attachment 1 3012 PRA Full Ap Attachment 1 8.26.2009.doc Yes Yes Printable Only

Health Health Care Services

 

180 0
   
Private Sector Not-for-profit institutions
 
   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 180 0 180 0 0 0
Annual IC Time Burden (Hours) 50,400 0 50,400 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.