Information Collection

ePass Database

IC 215922 under ICR 201612-0925-001 · OMB 0925-0717.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ePass Database	Form and Instruction
1 ePass Database Attachment 1 ePass Screenshots.docx	Form and Instruction

IC Title:

ePass Database

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	1	ePass Database	Attachment 1 ePass Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 940

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	940	940
Annual IC Time Burden (Hours)	470	470
Annual IC Cost Burden (Dollars)	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.