Information Collection

AFU Year 5

IC 211987 under ICR 201406-0925-002 · OMB 0925-0584.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 AFU Year 5	Form and Instruction
1 AFU-Year 5 Annual Followup English AFU-Y5 Annual Followup_Y5_1-14-2014_English.pdf	Form and Instruction
AFU Y5 Annual Followup-Y5-1-14-2014-Spanish.pdf AFU Year 5 Annual Followup Spanish	IC Document

IC Title:

AFU Year 5

Agency IC Tracking Number:

Is this a Common Form? No

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	1	AFU-Year 5 Annual Followup English	AFU-Y5 Annual Followup_Y5_1-14-2014_English.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,259

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	14,259	14,259
Annual IC Time Burden (Hours)	3,565	3,565
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
AFU Year 5 Annual Followup Spanish	AFU Y5 Annual Followup-Y5-1-14-2014-Spanish.pdf	06/23/2014

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