Information Collection

ICARE Dialogues Registration (OD)

IC 242630 under ICR 202002-0925-005 · OMB 0925-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Document Name Document Type
Form 1 ICARE Dialogues Registration (OD) Form and Instruction
1 ICARE Dialogues Registration ICARE Dialogues Registration with demographics supporting docs7_8_20.pdf Form and Instruction
ICARE Dialogues Registration OMB application registration.docx ICARE Dialogues Registration Template IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ICARE Dialogues Registration (OD)	Agency IC Tracking Number:

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
Form and Instruction	1	ICARE Dialogues Registration	ICARE Dialogues Registration with demographics supporting docs7_8_20.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ICARE Dialogues Registration Template	ICARE Dialogues Registration OMB application registration.docx	07/08/2020

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