OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Web-based Data Collection Form

IC 192521 under ICR 201004-0915-001 · OMB 0915-0332.

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

View Information Collection (IC)

Web-based Data Collection Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 004 - ECCS Attachment D - Indicator Reporting Form Attachment D Indicator Reporting Form_revised June 4 10.doc.docx Yes Yes Fillable Fileable

Health Health Care Services

 

52 0
   
State, Local, and Tribal Governments
 
   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 52 0 52 0 0 0
Annual IC Time Burden (Hours) 78 0 78 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.