Information Collection

Faith-based organizations

IC 219102 under ICR 201507-0990-011 · OMB 0990-0447.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Faith-based organizations	Form and Instruction
1 Example Written Notice of Beneficiary Protections WRITTEN NOTICE OF BENEFICIARY PROTECTIONS.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: 5 CFR 1320

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	1	Example Written Notice of Beneficiary Protections	WRITTEN NOTICE OF BENEFICIARY PROTECTIONS.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,372

Number of Respondents for Small Entity: 65

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,744	2,744
Annual IC Time Burden (Hours)	2,744	2,744
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.