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Federal forms, ICRs, and supporting documents

Information Collection

Questionnaire - Covered Entity Administrator or Privacy Officer(s)

IC 211635 under ICR 201511-0945-001 · OMB 0945-0007.

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Document Type
Other-questionnaire
Information Collection (IC) Details

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Questionnaire - Covered Entity Administrator or Privacy Officer(s)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-questionnaire 0945-0007Pre-Audit Entity Questionnaire fv11.24.15.pdf Yes Yes Fillable Printable

Health Public Health Monitoring

 

500 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 500 0 0 0 0 500
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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