Information Collection

OCR Pre-granted Automation Project

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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
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 %

table that charts list of burden
	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

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.