Information Collection

PEI Application BusinessPartner

IC 244201 under ICR 202010-0925-004 · OMB 0925-0767.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0767 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 PEI Application BusinessPartner	Form and Instruction
2 PEI Application - Business Partner PEI Application-BusinessPartner_final.pdf	Form and Instruction
2 PEI Application - Business Partner PEI Application-BusinessPartner_final.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

PEI Application BusinessPartner

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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 and Instruction	2	PEI Application - Business Partner	PEI Application-BusinessPartner_final.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 09-25-0156 âRecords of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD

FR Citation: 67 FR 60765

Number of Respondents: 6

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	5	5
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.