Information Collection

Application data for public-sector organizations

IC 199189 under ICR 201409-0920-010 · OMB 0920-0909.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0909 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Application data for public-sector organizations	Form and Instruction
Application - Public-Sector Attachment 4A DPRP Application (screenshots).docx	Form and Instruction
Attachment 4B_ DPRP Web Site (screenshot).docx Home Page Screenshot	IC Document
Attachment 4C Application Confirmation Pages (screenshots).docx DPRP Confirmation Page Screenshot	IC Document
Attachment 4D Application Received Confirm Email.docx DPRP Confirmation Email	IC Document
Attachment 4E Application Accepted Notice.docx DPRP Application Acceptance Email	IC Document
Attachment 4F Application Rejected Notice.docx DPRP Application Rejection Email	IC Document

IC Title:

Application data for public-sector organizations

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	none	Application - Public-Sector	Attachment 4A DPRP Application (screenshots).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 140

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	Previously Approved
Annual Number of Responses for this IC	140	128	12
Annual IC Time Burden (Hours)	140	128	12
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Home Page Screenshot	Attachment 4B_ DPRP Web Site (screenshot).docx	09/18/2014
DPRP Confirmation Page Screenshot	Attachment 4C Application Confirmation Pages (screenshots).docx	09/25/2014
DPRP Confirmation Email	Attachment 4D Application Received Confirm Email.docx	09/25/2014
DPRP Application Acceptance Email	Attachment 4E Application Accepted Notice.docx	09/25/2014
DPRP Application Rejection Email	Attachment 4F Application Rejected Notice.docx	09/25/2014

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