Information Collection

Vanguard Request Form

IC 220003 under ICR 201508-0925-002 · OMB 0925-0730.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0730 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Vanguard Request Form Form and Instruction
2 Vanguard Data Request Form Attachment A.2 Vanguard Data Request Form_02-04-2016_MARKED.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Vanguard Request Form	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Vanguard Data Request Form	Attachment A.2 Vanguard Data Request Form_02-04-2016_MARKED.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	17	17
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.