Information Collection

All other reporting, recordkeeping and 3rd party requirements (except items 12a, e, p and q)

IC 203943 under ICR 201307-3060-014 · OMB 3060-0819.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-0819 can be found here:

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Information Collection (IC) Details

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IC Title:	All other reporting, recordkeeping and 3rd party requirements (except items 12a, e, p and q)	Agency IC Tracking Number:	WCB

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 54

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: 16,100,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 35 %

	Approved	Previously Approved
Annual Number of Responses for this IC	41,765,759	41,765,759
Annual IC Time Burden (Hours)	23,129,335	23,129,335
Annual IC Cost Burden (Dollars)	0	0

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