Information Collection

Insulin Dependent Diabetic Supplement Documentation Form

IC 201719 under ICR 201611-0420-001 · OMB 0420-0550.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0420-0550 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PC-262-10 Insulin Dependent Diabetic Supplement Documentation Form	Form and Instruction
PC-262-10 Insulin Dependent Diabetic Supplemental Documentation Fo Insulin_Dependent_Diabetic_Supp_Doc.docx	Form and Instruction

IC Title:

Insulin Dependent Diabetic Supplement Documentation Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PC-262-10	Insulin Dependent Diabetic Supplemental Documentation Form	Insulin_Dependent_Diabetic_Supp_Doc.docx		Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title: Insulin Dependent Diabetic Supplemental Documentation Form

FR Citation: 70 FR 1

Number of Respondents: 14

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	14	-2	16
Annual IC Time Burden (Hours)	16	-19	35
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.