Information Collection

485 HRSA HAB Grantee Questionnaire

IC 204089 under ICR 201209-1090-001 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 485 485 HRSA HAB Grantee Questionnaire	Form and Instruction
485 485 HRSA HAB Grantee Questionnaire 2012 485 HRSA HAB Grantee Questionnaire - 2012 Final.docx	Form and Instruction

IC Title:

485 HRSA HAB Grantee Questionnaire

Agency IC Tracking Number:

485

IC Status: New

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	485	485 HRSA HAB Grantee Questionnaire	2012 485 HRSA HAB Grantee Questionnaire - 2012 Final.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.