Information Collection

Fax to Determine if Mailing was Received

IC 217350 under ICR 201507-0923-001 · OMB 0923-0053.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Fax to Determine if Mailing was Received	Form and Instruction
Fax Cover Sheet to Determine if Mailing was Received - P AppndxF Fax Cover Dtrmn Mailng Recvd.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	NA	Fax Cover Sheet to Determine if Mailing was Received - Promotion of the National ALS Registry	AppndxF Fax Cover Dtrmn Mailng Recvd.docx	NA	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 190

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	190	190
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	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.