Information Collection

2019-2020 All Facility Types -- Refusals

IC 217135 under ICR 201806-0910-014 · OMB 0910-0799.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0799 can be found here:

Documents and Forms

Document Name Document Type
Attachment C_Institutional_Retail_Data Collection Forms.doc Other-Survey
Attachment B_DC Institutional_Retail_Marking Instructions.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2019-2020 All Facility Types -- Refusals	Agency IC Tracking Number:	ORA

Is this a Common Form? No		IC Status: Modified

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
Other-Survey			Attachment C_Institutional_Retail_Data Collection Forms.doc		Yes	Yes	Fillable Fileable
Instruction			Attachment B_DC Institutional_Retail_Marking Instructions.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	2	2
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.