Information Collection

Implementation Plan

IC 207847 under ICR 201608-0915-003 · OMB 0915-0285.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0285 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 19 Implementation Plan	Form
Implementation Plan Instructions.docx	Instruction
19 Implementation Plan (track changes) Implementation Plan (track changes).doc	Form
19 Implementation plan 2017 Final Implementation plan 2017.doc	Form

IC Title:

Implementation Plan

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	19	Implementation Plan (track changes)	Implementation Plan (track changes).doc	Yes	Yes	Fillable Fileable
Form	19	Implementation plan 2017 Final	Implementation plan 2017.doc	Yes	Yes	Fillable Fileable
Instruction			Implementation Plan Instructions.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	900	500	400
Annual IC Time Burden (Hours)	2,700	1,500	1,200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.