Information Collection

LoC Cards Experts

IC 219965 under ICR 201602-0925-005 · OMB 0925-0746.

Documents and Forms

Document Name Document Type
Form 1 LoC Cards Experts Form and Instruction
1 Attachment 1 LoC Cards Website Screen shots Statement A_Attachment 1_LoC Cards WebsiteScreenShots.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	LoC Cards Experts	Agency IC Tracking Number:

Is this a Common Form? No		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	1	Attachment 1 LoC Cards Website Screen shots	Statement A_Attachment 1_LoC Cards WebsiteScreenShots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0200	FR Citation: 67 FR 60742

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	600	600
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.