OMB
.report
Search
HRSA Client-Level Data Reporting System: Service Provider Report
HRSA HAB Client-Level Data Reporting System
OMB: 0915-0323
IC ID: 187334
OMB.report
HHS/HSA
OMB 0915-0323
ICR 201804-0915-005
IC 187334
( )
Documents and Forms
Document Name
Document Type
Form C
HRSA Client-Level Data Reporting System: Service Provider Report
Form
C C - 2017_Service_Provider_Form_Screenshots.docx
C - 2017_Service_Provider_Form_Screenshots.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HRSA Client-Level Data Reporting System: Service Provider Report
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
C
C - 2017_Service_Provider_Form_Screenshots.docx
C - 2017_Service_Provider_Form_Screenshots.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,793
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,793
0
0
0
0
1,793
Annual IC Time Burden (Hours)
30,481
0
0
0
0
30,481
Annual IC Cost Burden (Dollars)
0
0
0
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.
