Information Collection

30 CFR 250, Subpart E; 250.513 thru 526

IC 210256 under ICR 201402-1014-002 · OMB 1014-0026.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
eWell_Form-124_screens 2013.pdf Other-actual screen shots from eWell
PRA Statement for eWell.docx Other-Revised PRA Statement for eWel

Information Collection (IC) Details

View Information Collection (IC)

layout table

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
Other-actual screen shots from eWell eWell_Form-124_screens 2013.pdf Yes Yes Fillable Fileable
Other-Revised PRA Statement for eWell PRA Statement for eWell.docx Yes No Printable Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,029 0 1,029 0 0 0
Annual IC Time Burden (Hours) 529 0 529 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 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.