Intermediate Provider Registry, WC Docket No. 13-39

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-1259 can be found here:

Documents and Forms

Document Name Document Type
IPR_screens - (final version).docx Other-IPR Screenshots

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Intermediate Provider Registry, WC Docket No. 13-39	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 47 CFR 64.2115

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-IPR Screenshots			IPR_screens - (final version).docx		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 168	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	168	168
Annual IC Time Burden (Hours)	168	168
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.