Information Collection

FITBIR Data Access Request

IC 207552 under ICR 201609-0925-001 · OMB 0925-0677.

Documents and Forms

Document Name Document Type
Form 1 FITBIR Data Access Request Form and Instruction
1 FITBIR Data Access Request FITBIR data access V2 6-6-13.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	FITBIR Data Access Request	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Form and Instruction	1	FITBIR Data Access Request	FITBIR data access V2 6-6-13.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-40	40
Annual IC Time Burden (Hours)	-63	63
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.