Information Collection

Single Audit Focus Group

IC 220779 under ICR 201603-4040-001 · OMB 4040-0017.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OMB Control 4040-0017 Collection1 HHS DAP_Single Audit Questionnaire_03172016.docx	Other-questionnaire
March25-4040-0017 Generic - Short Supporting Statement Single Audit.docx Short Supporting statement	IC Document
March25-4040SA 2 SupportingStatementAforSingleAuditICRFinal.docx Support statement A	IC Document
HHS DAP NGMA SA Guided Discussion_03232016.pptx Discussion Guide	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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
Other-questionnaire			OMB Control 4040-0017 Collection1 HHS DAP_Single Audit Questionnaire_03172016.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Short Supporting statement	March25-4040-0017 Generic - Short Supporting Statement Single Audit.docx	03/25/2016
Support statement A	March25-4040SA 2 SupportingStatementAforSingleAuditICRFinal.docx	03/25/2016
Discussion Guide	HHS DAP NGMA SA Guided Discussion_03232016.pptx	03/25/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.