Information Collection

Weekly Reporting

IC 212550 under ICR 201407-0938-013 · OMB 0938-1215.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1215 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Weekly Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.210

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: 99	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	5,148	5,148
Annual IC Time Burden (Hours)	43,346	43,346
Annual IC Cost Burden (Dollars)	972,972	972,972

Documents for IC

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