Information Collection

Faith-based organizations

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Faith-based organizations	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:

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 %

	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

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.