Information Collection Request

Facts for Consumers About Health

ICR 201208-0955-002 · OMB 0955-0002 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Sample PHR Mock Notice OMB 8 5 09.pdf Supplementary Document Uploaded 2009-09-22 Available
Revised Attachments ABCD 091709.doc Supplementary Document Uploaded 2009-09-22 Available
Sample mock privacy document OMB 8 5 09.doc Supplementary Document Uploaded 2009-09-22 Available
60-Day FRN Comments Response to ARMA International v2 Final.doc Supplementary Document Uploaded 2009-09-22 Available
0990-fACTSFOR CONSUMER.doc Supporting Statement B Uploaded 2009-03-24 Available
Revised Supporting Statement to OMB 091709.doc Supporting Statement A Uploaded 2009-09-22 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
189374 Participants selected Other-Moderator Guide New
189373 Individuals Screened Other-Moderator Guide New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2012 36 Months From Approved
126 0 0
84 0 0
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Individuals Screened
Participants selected

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 126 0 0 126 0 0
Annual Time Burden (Hours) 84 0 0 84 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No