Information Collection Request

Service Provider and Billed Entity Identification Number and Contact Information Form

ICR 201610-3060-004 · OMB 3060-0824 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
PRA 3060-0824 Explanation of Non-Substantive Changes_10 12 16_2.doc Justification for No Material/Nonsubstantive Change Uploaded 2016-10-12 Available
Multiple Collections Non Substantive Change Request (June 2016).doc Justification for No Material/Nonsubstantive Change Uploaded 2016-06-24 Available
0824_Explanation_of_Non-Substantive_Changes (May 2016).doc Justification for No Material/Nonsubstantive Change Uploaded 2016-05-16 Repair queued
0824_Explanation_of_Non-Substantive_Changes_(03-11-16).doc Justification for No Material/Nonsubstantive Change Uploaded 2016-03-11 Repair queued
3060-0824 SS (2015 final).docx Supporting Statement A Uploaded 2015-10-02 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
44158 Service Provider and Bill Entity Identification Number and Contact Information Form Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2018 11/30/2018 11/30/2018
26,000 0 26,000
19,500 0 19,500
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 26,000 26,000 0 0 0 0
Annual Time Burden (Hours) 19,500 19,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No