Information Collection

Donor

IC 43644 under ICR 201704-0930-001 · OMB 0930-0158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0158 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Federal CCF Federal CCF Donor	Form and Instruction
Form DOT Federal CCF DOT Federal CCF Donor	Form and Instruction
Federal CCF Federal CCF Att C Fed CCF.pdf	Form and Instruction
DOT Federal CCF DOT Federal CCF DOT 2013_Fed CCF.pdf	Form and Instruction
Att A Executive Order 12564.pdf Authorizing Leg and Exec Order 12564	IC Document
Att B URMG revised 2017.pdf UrMG	IC Document

IC Title:

Donor

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	Federal CCF				Yes	Yes	Fillable Fileable
Form and Instruction	DOT Federal CCF				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,400,000

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,400,000	-750,000	6,150,000
Annual IC Time Burden (Hours)	432,000	-80,500	512,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Leg and Exec Order 12564		04/27/2017
UrMG		04/27/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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