Information Collection

Individuals

IC 202159 under ICR 201209-0938-009 · OMB 0938-1166.

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Information Collection (IC) Details

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IC Title:	Individuals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 45 CFR 162.410 45 CFR 162.512

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: 160,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to New Statute	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160,000	-160,000
Annual IC Time Burden (Hours)	52,800	-52,800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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