Information Collection

Registrations for STD/TB Clinics

IC 221299 under ICR 201604-0915-002 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Registrations for STD/TB Clinics Form and Instruction
1 340BRegistration-Covered Entities STD-Revised 340BRegistration-Covered Entities STD-Revised.docx Form and Instruction
2 340BRegistration-Covered Entities TB-Revised 340BRegistration-Covered Entities TB-Revised.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Registrations for STD/TB Clinics	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	340BRegistration-Covered Entities STD-Revised	340BRegistration-Covered Entities STD-Revised.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	340BRegistration-Covered Entities TB-Revised	340BRegistration-Covered Entities TB-Revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 647	Number of Respondents for Small Entity: 170

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	647	647
Annual IC Time Burden (Hours)	647	647
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.