Information Collection

Extension Requests and Appeals

IC 225087 under ICR 202001-0925-001 · OMB 0925-0586.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0586 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Extension Requests and Appeals	Form and Instruction
4 Request for the Extension of the Results Information Sub Attachment 7 – Request for the Extension of the Results Information Submission Deadline (Reference Document and Screenshots of D	Form and Instruction

IC Title:

Extension Requests and Appeals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

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	4	Request for the Extension of the Results Information Submission Deadline (Reference document and Screenshots of Data Entry Forms)	Attachment 7 â Request for the Extension of the Results Information Submission Deadline (Reference Document and Screenshots of Data Entry Forms).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-250	250
Annual IC Time Burden (Hours)	-500	500
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.