Information Collection

FSR 279 DOI Main, FSR 280 CMS FCSO

IC 191121 under ICR 201101-1090-002 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FSR 279 FSR 279 DOI Main, FSR 280 CMS FCSO	Form
FSR 279 DOI Main 279 DOI Main_DOI Main Questionnaire Model and Custom 10-26-09.xls	Form
FSR 280 HHS CMS FCSO 280 CMS FCSO Custom Questions for OMB 10-26-09.xls	Form
Justification for ICs to generic ICR 1090-0008.doc Justification for ICs to generic ICR 1090-0008	IC Document

IC Title:

FSR 279 DOI Main, FSR 280 CMS FCSO

Agency IC Tracking Number:

FSR 279, FSR 280

IC Status: Unchanged

Obligation to Respond: Voluntary

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	FSR 279	DOI Main	279 DOI Main_DOI Main Questionnaire Model and Custom 10-26-09.xls		Yes	Yes	Fillable Fileable
Form	FSR 280	HHS CMS FCSO	280 CMS FCSO Custom Questions for OMB 10-26-09.xls		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification for ICs to generic ICR 1090-0008	Justification for ICs to generic ICR 1090-0008.doc	10/27/2009

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