Information Collection

Notice of Award -- Proof of Concept Test

IC 223704 under ICR 201603-4040-001 · OMB 4040-0017.

Documents and Forms

Document Name Document Type
4040-0017 HHS NOA Questionnaire_09232016.docx Other-questionnaire
Group A - Standardized NOAs 09232016.pdf Group A Standardized NOA IC Document
Group B - Non-Standardized NOAs 09232016.pdf Group B Non-Standardized NOAs IC Document
Group A DCT Answer Key_09232016.docx Group A Answer Key IC Document
Group B DCT Answer Key_09232016.docx Group B Answer Key IC Document
NOA Webinar Deck_09232016.pptx Webinar Deck IC Document
NOA Instructions and DCT_09232016.docx Instructions IC Document
4040-0017_Short Supporting Statement_NOA_09232016.docx Short Supporting Statement IC Document
4040-0017_Supporting Statement A_NOA_09232016.docx Supporting Statement A IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Award -- Proof of Concept Test	Agency IC Tracking Number:

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
Other-questionnaire			4040-0017 HHS NOA Questionnaire_09232016.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Group A Standardized NOA	Group A - Standardized NOAs 09232016.pdf	09/26/2016
Group B Non-Standardized NOAs	Group B - Non-Standardized NOAs 09232016.pdf	09/26/2016
Group A Answer Key	Group A DCT Answer Key_09232016.docx	09/26/2016
Group B Answer Key	Group B DCT Answer Key_09232016.docx	09/26/2016
Webinar Deck	NOA Webinar Deck_09232016.pptx	09/26/2016
Instructions	NOA Instructions and DCT_09232016.docx	09/26/2016
Short Supporting Statement	4040-0017_Short Supporting Statement_NOA_09232016.docx	09/26/2016
Supporting Statement A	4040-0017_Supporting Statement A_NOA_09232016.docx	09/26/2016

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