Information Collection

RWHAP UOB Tables Summary

IC 238609 under ICR 201911-0906-001 · OMB 0906-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0047 can be found here:

Documents and Forms

Document Name Document Type
Form 1 RWHAP UOB Tables Summary Form
1 RWHAP UOB Tables Summary 02-22-2019.pdf RWHAP UOB Tables Summary 02-22-2019.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	RWHAP UOB Tables Summary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	RWHAP UOB Tables Summary 02-22-2019.pdf	RWHAP UOB Tables Summary 02-22-2019.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 111	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	111	111
Annual IC Time Burden (Hours)	56	56
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.