Information Collection Request
ICR 201606-0920-010 · OMB 0920-0639 · Public filing
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-0639 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form B |
Form | Modified | Available |
 Attachment F HSRB 10-DCAS-NR01 060310 non-research.pdf |
Supplementary Document | Uploaded 2016-06-27 | Available |
| Attachment B FRN 60-day 2016-06708.pdf |
Supplementary Document | Uploaded 2016-06-27 | Available |
 Attachment H Public Comment FRN.docx |
Supplementary Document | Uploaded 2016-06-27 | Available |
| Attachment G ANWAG comments FRN.pdf |
Supplementary Document | Uploaded 2016-06-27 | Available |
| SS B.docx |
Supporting Statement B | Uploaded 2016-06-27 | Available |
| Supporting Statement A 6.20.2016.docx |
Supporting Statement A | Uploaded 2016-06-27 | Available |
 Attachment A2.doc |
Supplementary Document | Uploaded 2013-05-22 | Available |
| Attachment A1.pdf |
Supplementary Document | Uploaded 2013-05-22 | Available |
| Attachment A.pdf |
Supplementary Document | Uploaded 2013-05-22 | Available |
| Attachment D1 SEC Form B Instructions.rev 2.pdf |
Supplementary Document | Uploaded 2010-07-14 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 7107 |  Form A 42 CFR 83.9 |
Instruction | Modified | |
| 180186 | Authorization Form on behalf of Claimant under 42 CFR 83.7 |
Instruction | Modified | |
| 180185 | Petitioner Appealing Final Decision under 42 CFR 83.18 |
Instruction | Modified | |
| 180184 | Petitioner Submission Format other than Form B 42 CFR 83.9 |
Instruction | Unchanged | |
| 180183 | Form B 42 CFR Part 83.9 |
Form | Modified | Form B |
ICR Details
| OMB Control No | 0920-0639 |
|---|