Information Collection

Federalwide Assurance (FWA)

IC 10411 under ICR 201702-0990-003 · OMB 0990-0278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0278 can be found here:

Documents and Forms

Document Name Document Type
0990-0278_Form for the Federalwide Assurance.docx Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Federalwide Assurance (FWA)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 46

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey			0990-0278_Form for the Federalwide Assurance.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	28,000	5,900	22,100
Annual IC Time Burden (Hours)	14,000	2,950	11,050
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.