Information Collection

Respiratory Protective Devices-42 CFR part 84-Regulation (Audit)

IC 197842 under ICR 201801-0920-002 · OMB 0920-0109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0109 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0109 Respiratory Protective Devices-42 CFR part 84-Regulation (Audit) Form
0920-0109 Audit Form Attachment 5- Draft Audit Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Respiratory Protective Devices-42 CFR part 84-Regulation (Audit)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 84

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0109	Audit Form	Attachment 5- Draft Audit Form.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59	Number of Respondents for Small Entity: 34

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	59	59
Annual IC Time Burden (Hours)	1,416	1,416
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.