Information Collection

Certification for Continued Listing Form

IC 186800 under ICR 201206-0935-003 · OMB 0935-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0143 can be found here:

Documents and Forms

Document Name Document Type
Form Form #2 Certification for Continued Listing Form Form and Instruction
Form #2 PSO Certification for Continued Listing Form Attachment E -- PSO Certification for Continued Listing.fin.docx www.pso.ahrq.gov/listing/certconlistfm.htm Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification for Continued Listing Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form #2	PSO Certification for Continued Listing Form	Attachment E -- PSO Certification for Continued Listing.fin.docx	http://www.pso.ahrq.gov/listing/certconlistfm.htm	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	192	192
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.