Information Collection

HAB Client Report With Data Systems

IC 187336 under ICR 201101-0915-002 · OMB 0915-0323.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0323 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
D - 2010_Client-level_Data_Fields.doc	Instruction

IC Title:

HAB Client Report With Data Systems

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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
Instruction			D - 2010_Client-level_Data_Fields.doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,822

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,822	-227	2,049
Annual IC Time Burden (Hours)	6,833	-1,955	8,788
Annual IC Cost Burden (Dollars)	0	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.