Information Collection

New RoPR Record

IC 203257 under ICR 201707-0935-001 · OMB 0935-0203.

Documents and Forms

Document Name Document Type
Form Form #1 New RoPR Record Form and Instruction
Form #1 RoPR Data Collection Instrument Attachment B - EB_ EDIT Questionnaires_Data Collection Instruments.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	New RoPR Record	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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
Form and Instruction	Form #1	RoPR Data Collection Instrument	Attachment B - EB_ EDIT Questionnaires_Data Collection Instruments.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	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: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-59	59
Annual IC Time Burden (Hours)	-44	44
Annual IC Cost Burden (Dollars)	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.