Information Collection

Category 3 Measures (2 measures)

IC 209974 under ICR 201701-0990-006 · OMB 0990-0416.

Documents and Forms

Document Name Document Type
0990-0416_Attachment E_Form_Category 3_PAF PM Renewal_0990_0416.docx Other-FORM

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Category 3 Measures (2 measures)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-FORM			0990-0416_Attachment E_Form_Category 3_PAF PM Renewal_0990_0416.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	5	-1	6
Annual IC Time Burden (Hours)	15	-3	18
Annual IC Cost Burden (Dollars)	0	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.