Information Collection

HHS Burden Estimate for 4040-0010

IC 211153 under ICR 201404-1225-006CF · OMB 4040-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 4040-0010 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4040-0010 Key Contacts HHS Burden Estimate for 4040-0010	Form
Form 4040-0010 Project/Performance Site Location HHS Burden Estimate for 4040-0010	Form
Form 4040-0010 Project Abstract HHS Burden Estimate for 4040-0010	Form
4040-0010 Key Contacts Key_Contacts-V1.0.pdf	Form
4040-0010 Project/Performance Site Location PerformanceSite_1_4-V1.4.pdf	Form
4040-0010 Project Abstract Project_Abstract-V1.1.pdf	Form

IC Title:

HHS Burden Estimate for 4040-0010

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4040-0010	Yes	Yes	Fillable Fileable
Form	4040-0010	Yes	Yes	Fillable Fileable
Form	4040-0010	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,600

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	1,300	1,300
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.

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