Information Collection

Assurance and Certification Requirements

IC 236662 under ICR 201906-0945-003 · OMB 0945-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0945-0008 can be found here:

Documents and Forms

Document Name Document Type
0945-0008_Form for 88.4 HHS-690 - revJune19_2019.docx Other-form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Assurance and Certification Requirements	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-form			0945-0008_Form for 88.4 HHS-690 - revJune19_2019.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 158,890	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	158,890	158,890
Annual IC Time Burden (Hours)	635,560	635,560
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.