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Federal forms, ICRs, and supporting documents

Information Collection

Pilot Participation Form

IC 221212 under ICR 201603-4040-001 · OMB 4040-0017.

Documents and Forms
Document Name
Document Type
Other-form
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Pilot Participation Form
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-form HHS DAP Section 5 Grants Pilot _Pilot Participation Form_04082016_v2 (2).docx Yes Yes Fillable Printable

Health Public Health Monitoring

 

1,076 0
   
Private Sector Not-for-profit institutions
 
   100 %

  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 1,076 0 1,076 0 0 0
Annual IC Time Burden (Hours) 269 0 269 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
mini supporting st 4040-0017_Short Supporting Statement Pilot Participation Form_April2016_v2.docx 04/21/2016
email PPF Cover Email_04212016.docx 04/21/2016
Support statement A 4040-0017_SupportingStatementAforPPFICR_April2016_v2.docx 04/21/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.