Information Collection

Annual Recertification for Other Entities

IC 190352 under ICR 201504-0915-001 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Annual Recertification for Other Entities	Form
2 RW-Recertification-Revised RW-Recertification-Revised.pdf	Form
1 Conmmunity Health Center Recert Conmmunity Health Center Recert.pdf	Form and Instruction

IC Title:

Annual Recertification for Other Entities

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	2	RW-Recertification-Revised	RW-Recertification-Revised.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	1	Conmmunity Health Center Recert	Conmmunity Health Center Recert.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,474

Number of Respondents for Small Entity: 730

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	2,474	-3,207	5,681
Annual IC Time Burden (Hours)	619	-2,222	2,841
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.