Model Notices

Process for Obtaining Waivers of the Annual Limits Requirements of PHS Act Section 2711

OMB: 0938-1105

IC ID: 195130

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Model Notices
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 147.126

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

1,455 0
   
Private Sector Businesses or other for-profits, 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 2,978,385 0 0 0 0 2,978,385
Annual IC Time Burden (Hours) 99,280 0 0 0 0 99,280
Annual IC Cost Burden (Dollars) 1,459,409 0 0 0 0 1,459,409

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