Information Collection

Federalwide Assurance (FWA)

IC 10411 under ICR 201105-0990-001 · OMB 0990-0278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0278 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990-0278 Federalwide Assurance (FWA)	Form and Instruction
0990-0278-Proposed Terms of the Federalwide Assurance PRA _ 31 March 2011.docx	Instruction
0990-0278-Proposed Instructions for the Federalwide Assurance PRA to Toni_31 March 2011.doc	Instruction
0990-0278 FWA 0990-0278-Proposed FWA Form-For both US and non-US institutions_PRA _31 March 2011.doc	Form and Instruction

IC Title:

Federalwide Assurance (FWA)

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 46

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0990-0278	FWA	0990-0278-Proposed FWA Form-For both US and non-US institutions_PRA _31 March 2011.doc	Yes	Yes	Fillable Fileable
Instruction			0990-0278-Proposed Terms of the Federalwide Assurance PRA _ 31 March 2011.docx	Yes	Yes	Fillable Fileable
Instruction			0990-0278-Proposed Instructions for the Federalwide Assurance PRA to Toni_31 March 2011.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,000

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	22,000	2,000	20,000
Annual IC Time Burden (Hours)	11,000	-4,000	15,000
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.