Information Collection

Reabstraction Study - Traditional and CHC Providers

IC 220064 under ICR 201902-0920-021 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att I-2018-2019 PRF Burden Abstract.docx	Instruction
Att J-2018 Reabstraction Burden 020619.docx	Instruction
Att G-2018 Reabstraction Instrument.docx 2018 Reabstraction Study Screenshots	IC Document

IC Title:

Reabstraction Study - Traditional and CHC Providers

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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			Att I-2018-2019 PRF Burden Abstract.docx		Yes	Yes	Fillable Fileable
Instruction			Att J-2018 Reabstraction Burden 020619.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Human Resources Utilzation 09-20-0167

FR Citation: 49 FR 37697

Number of Respondents: 3

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	-690	720
Annual IC Time Burden (Hours)	1	-11	12
Annual IC Cost Burden (Dollars)	16	16	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2018 Reabstraction Study Screenshots	Att G-2018 Reabstraction Instrument.docx	02/28/2019

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