Information Collection

_HRSA RWHAP COVID-19 Data Report

IC 241923 under ICR 202011-0906-001 · OMB 0906-0053.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 _HRSA RWHAP COVID-19 Data Report	Form
Form 1 Coronavirus 2019 (COVID-19) Data Report Form.docx _HRSA RWHAP COVID-19 Data Report	Form
1 Coronavirus 2019 (COVID-19) Data Report Form.docx Coronavirus 2019 (COVID-19) Data Report Form.docx	Form
1 Coronavirus 2019 (COVID-19) Data Report Form.docx Coronavirus 2019 (COVID-19) Data Report Form.docx	Form
Attachment B - 2020_CDR_Instruction_Manual_08_03_20_508.pdf Attachment B - 2020_CDR_Instruction_Manual_08_03_20_508	IC Document
Attachment B - 2020_CDR_Instruction_Manual_08_03_20_508.pdf Attachment B - 2020_CDR_Instruction_Manual_08_03_20_508	IC Document

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,045

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	24,540	0	24,540
Annual IC Time Burden (Hours)	78,528	29,448	49,080
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment B - 2020_CDR_Instruction_Manual_08_03_20_508		11/15/2020

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].