Information Collection

Application data for public-sector organizations

IC 199189 under ICR 201203-0920-003 · OMB 0920-0909.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0909 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4a 4a Revised Application data for public-sector organizations	Form and Instruction
Application - public sector Application data for public-sector organizations	Form
4a 4a Revised Att 4a_revised_DPRP Application Page updates.pdf	Form and Instruction
Application - public sector Attachment 4A - DPRP application page (07.29.11).pptx	Form
Attachment 4B - DPRP homepage (07.29.11).pptx Att 4b - DPRP homepage	IC Document
Attachment 4C - DPRP Application Confirmation Page.pptx Att 4c - Application confirmation page	IC Document
Attachment 4D - Application Confirmation Email.docx Att 4d - Application confirmation email	IC Document
Attachment 4E - Application Acceptance (07.29.11).docx Att 4e - Application acceptance	IC Document
Attachment 4F - Application Rejection (07.29.11).docx Att 4f - Application rejection	IC Document
Att 4b_revised_DPRP Home Page and Confirmation Email updates.pdf Att 4b_revised_DPRP Home Page and Confirmation Email updates	IC Document

IC Title:

Application data for public-sector organizations

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	4a				Yes	Yes	Fillable Fileable
Form	none				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 4b - DPRP homepage		09/01/2011
Att 4c - Application confirmation page		09/01/2011
Att 4d - Application confirmation email		09/01/2011
Att 4e - Application acceptance		09/01/2011
Att 4f - Application rejection		09/01/2011
Att 4b_revised_DPRP Home Page and Confirmation Email updates		03/07/2012

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

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