Information Collection

SOAR Data Form

IC 198968 under ICR 201409-0930-001 · OMB 0930-0329.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0329 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SOAR Form SOAR Data Form	Form and Instruction
SOAR Form SOAR Form SOAR Form Attachment A 2014 Final.docx	Form and Instruction

IC Title:

SOAR Data Form

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	SOAR Form	SOAR Form	SOAR Form Attachment A 2014 Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,100	-26,700	28,800
Annual IC Time Burden (Hours)	525	-6,675	7,200
Annual IC Cost Burden (Dollars)	0	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.