Information Collection

Donor

IC 43644 under ICR 201007-0930-002 · OMB 0930-0158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0158 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Federal CCF Donor	Form and Instruction
Federal CCF Federal CCF Attachment D.pdf	Form and Instruction
Attachment A.pdf Authorizing Legislation and Exec Order	IC Document
Attachment B.pdf Mandatory Guidelines	IC Document
Attachment C.pdf Mandatory Guidelines Effect. Date	IC Document

IC Title:

Donor

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Federal CCF	Federal CCF	Attachment D.pdf		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,096,000

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	7,096,000	-21,288,168	28,384,168
Annual IC Time Burden (Hours)	567,680	-1,219,129	1,786,809
Annual IC Cost Burden (Dollars)	2,212,000	122,000	2,090,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation and Exec Order	Attachment A.pdf	07/15/2010
Mandatory Guidelines	Attachment B.pdf	07/15/2010
Mandatory Guidelines Effect. Date	Attachment C.pdf	07/15/2010

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