Information Collection

DUA for AIM data

IC 237429 under ICR 202009-0935-005 · OMB 0935-0246.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0246 can be found here:

Documents and Forms

Document Name Document Type
Form R DUA for AIM data Form and Instruction
R DUA for AIM data Attachment R_ Key DUA provisions_revised 062419- clean 7.30.19.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DUA for AIM data	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	R	DUA for AIM data	Attachment R_ Key DUA provisions_revised 062419- clean 7.30.19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 258	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: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	258	258
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.