Information Collection

42 CFR 50.605(a)(5) - Institutions (Disclosure)

IC 186927 under ICR 201809-0925-001 · OMB 0925-0417.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0417 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attach 4 - Instructions (3).doc	Instruction

IC Title:

42 CFR 50.605(a)(5) - Institutions (Disclosure)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 50.605(a)(5)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attach 4 - Instructions (3).doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	10,000	10,000
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.