Information Collection

SBC disclosure

IC 199007 under ICR 201202-0938-001 · OMB 0938-1146.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	SBC disclosure	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 147.200

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 333	Number of Respondents for Small Entity: 35

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 54 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	13,000,000	13,000,000
Annual IC Time Burden (Hours)	300,000	300,000
Annual IC Cost Burden (Dollars)	1,300,000	1,300,000

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