Information Collection

Business: Provider Data Manager

IC 205111 under ICR 201408-0584-007 · OMB 0584-0580.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0580 can be found here:

Documents and Forms

Document Name Document Type
App_X Provider Data Request Letter PRAO recommendations CMRev 11-12-14.V2.docx Other-App_X Provider Data Request Le

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Business: Provider Data Manager	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-App_X Provider Data Request Letter PRAO recommendations CMRev 11-12-14.V2			App_X Provider Data Request Letter PRAO recommendations CMRev 11-12-14.V2.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: Privacy Act of 1974	FR Citation: 5 FR 552

Number of Respondents: 157	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	157	-1,679	1,836
Annual IC Time Burden (Hours)	13	-68	81
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.