Information Collection

RPPR (or 2590 or 416-9)

IC 7244 under ICR 201306-0925-003 · OMB 0925-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 4 - PHS 2590 Instructions.docx	Instruction
Attachment 6 - PHS 416-9 Instructions.docx	Instruction
1 PHS 2590 Attachment 3 - PHS 2590 forms.pdf	Form
2 PHS 416-9 Attachment 5 - PHS 416-9 forms.pdf	Form and Instruction
3 RPPR Attachment 7 - RPPR Screen Shots.pdf	Form
Attachment 8 - RPPR Instruction Guide.docx Attachment 8 - RPPR Instruction Guide	IC Document

IC Title:

RPPR (or 2590 or 416-9)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 4 - PHS 2590 Instructions.docx	Yes	Yes	Fillable Fileable
Form	1	PHS 2590	Attachment 3 - PHS 2590 forms.pdf	Yes	Yes	Fillable Printable
Form and Instruction	2	PHS 416-9	Attachment 5 - PHS 416-9 forms.pdf	Yes	Yes	Fillable Fileable
Instruction			Attachment 6 - PHS 416-9 Instructions.docx	Yes	Yes	Fillable Fileable
Form	3	RPPR	Attachment 7 - RPPR Screen Shots.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40,569

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	40,569	40,569
Annual IC Time Burden (Hours)	608,535	608,535
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 8 - RPPR Instruction Guide	Attachment 8 - RPPR Instruction Guide.docx	06/28/2012

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