Information Collection

B VCA Abdominal Wall Designated Program Application

IC 226690 under ICR 201705-0915-002 · OMB 0915-0184.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0184 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form B12 B VCA Abdominal Wall Designated Program Application	Form and Instruction
B12 B12 VCA_AW_Kidney_Updated.doc M3_VCA_AW_Kidney_Updated.doc	Form and Instruction
B13 B13 VCA_AW_Liver_Updated.doc M4_VCA_AW_Liver_Updated.doc	Form and Instruction
B14 B14 _VCA_AW_Pancreas_Updated.doc M5_VCA_AW_Pancreas_Updated.doc	Form and Instruction
B15 B15 VCA_AW_Intestine_Updated.doc M2_VCA_AW_Intestine_Updated.doc	Form and Instruction

IC Title:

B VCA Abdominal Wall Designated Program Application

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	B12	B12 VCA_AW_Kidney_Updated.doc	M3_VCA_AW_Kidney_Updated.doc	Yes	Yes	Fillable Fileable
Form and Instruction	B13	B13 VCA_AW_Liver_Updated.doc	M4_VCA_AW_Liver_Updated.doc	Yes	Yes	Fillable Fileable
Form and Instruction	B14	B14 _VCA_AW_Pancreas_Updated.doc	M5_VCA_AW_Pancreas_Updated.doc	Yes	Yes	Fillable Fileable
Form and Instruction	B15	B15 VCA_AW_Intestine_Updated.doc	M2_VCA_AW_Intestine_Updated.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	26	26
Annual IC Time Burden (Hours)	78	78
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.