Information Collection

OCR Pre-granted Automation Project

IC 10370 under ICR 201102-0990-001 · OMB 0990-0243.

Documents and Forms

Document Name Document Type
Form 1 OCR Pre-granted Automation Project Form
1 0990-0243-Civil Rights Infomation Request Form RevDS8-9- 0990-0243-Civil Rights Infomation Request Form RevDS8-9-10[2].doc Form

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	0990-0243-Civil Rights Infomation Request Form RevDS8-9-10[2]	0990-0243-Civil Rights Infomation Request Form RevDS8-9-10[2].doc		Yes	Yes	Fillable Fileable

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 %

	Approved	Program Change Due to Agency Discretion
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

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.