Information Collection

OCR Pre-granted Automation Project

IC 10370 under ICR 201011-0990-003 · OMB 0990-0243.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0243 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0243-Civil Rights Infomation Request Form RevDS8-9-10.doc	Other-form
690 0990-0243 Form HHS-690 (2) 0990-0243 Form HHS-690 (2).doc	Form

IC Title:

OCR Pre-granted Automation Project

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 80

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
Other-form			0990-0243-Civil Rights Infomation Request Form RevDS8-9-10.doc		No	No	Paper Only
Form	690	0990-0243 Form HHS-690 (2)	0990-0243 Form HHS-690 (2).doc		No		Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,900

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	2,900	2,900
Annual IC Time Burden (Hours)	23,200	23,200
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.