Information Collection

Consolidated Federal Financial Report (FFR)

IC 221468 under ICR 201603-4040-001 · OMB 4040-0017.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HHS DAP_Consolidated FFR Survey_May2016_051116.docx	Other-Survey
CFFR Form Completion Cover Email_051116.docx Cover Email	IC Document
4040-0017_SupportingStatement A CFFR_051116.docx Supporting Statment A	IC Document
4040-0017_Short Supporting Statement CFFR_051116.docx Supporting Statement	IC Document
CFFR Form Completion Kickoff_051116.pptx Kickoff	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-Survey			HHS DAP_Consolidated FFR Survey_May2016_051116.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	320	320
Annual IC Time Burden (Hours)	53	53
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover Email	CFFR Form Completion Cover Email_051116.docx	05/11/2016
Supporting Statment A	4040-0017_SupportingStatement A CFFR_051116.docx	05/11/2016
Supporting Statement	4040-0017_Short Supporting Statement CFFR_051116.docx	05/11/2016
Kickoff	CFFR Form Completion Kickoff_051116.pptx	05/11/2016

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