Information Collection

Federalwide Assurance (FWA)

IC 10411 under ICR 202004-0990-006 · OMB 0990-0278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0278 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990-0978 Federalwide Assurance (FWA)	Form
0990-0978 FWA Form FWA Form.pdf	Form

IC Title:

Federalwide Assurance (FWA)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 46

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	0990-0978	FWA Form	FWA Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	28,000	28,000
Annual IC Time Burden (Hours)	14,000	14,000
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.