Information Collection

Initial VQIP applications and applications w/additional information

IC 223077 under ICR 202006-0910-001 · OMB 0910-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0840 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Initial VQIP applications and applications w/additional information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	-90	100
Annual IC Time Burden (Hours)	1,800	-16,200	18,000
Annual IC Cost Burden (Dollars)	0	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.