Information Collection

Donor

IC 43644 under ICR 202006-0930-004 · OMB 0930-0158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0158 can be found here:

Documents and Forms

Document Name Document Type
Form 2020 Proposed Fed Donor Form and Instruction
2020 Proposed Fed 2020 Proposed Fed CCF Proof Changes Highlighted 2020_Proposed_FedCCF_PROOF_Changes Highlighted.pdf Form and Instruction
Executive Order 12564.Final.pdf Executive Order 12564 IC Document
URMG revised 2017.Final.pdf UrMG revised 2017 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Donor	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
Form and Instruction	2020 Proposed Fed CCF Proof Changes Highlighted	2020 Proposed Fed CCF Proof Changes Highlighted	2020_Proposed_FedCCF_PROOF_Changes Highlighted.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,726,610	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,726,610	1,326,610	5,400,000
Annual IC Time Burden (Hours)	538,129	106,129	432,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Executive Order 12564	Executive Order 12564.Final.pdf	06/30/2020
UrMG revised 2017	URMG revised 2017.Final.pdf	06/30/2020

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