Information Collection

Registrations for STD/TB Clinics

IC 221299 under ICR 201908-0915-001 · OMB 0915-0327.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0327 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Registrations for STD/TB Clinics	Form and Instruction
1 340BRegistration-Covered Entities STD-Revised 340BRegistration-Covered Entities STD-Revised.docx	Form and Instruction
2 340BRegistration-Covered Entities TB-Revised 340BRegistration-Covered Entities TB-Revised.docx	Form and Instruction

IC Title:

Registrations for STD/TB Clinics

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	1	340BRegistration-Covered Entities STD-Revised	340BRegistration-Covered Entities STD-Revised.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	340BRegistration-Covered Entities TB-Revised	340BRegistration-Covered Entities TB-Revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 647

Number of Respondents for Small Entity: 170

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-647	647
Annual IC Time Burden (Hours)	-647	647
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.