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
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	Coronavirus 2019 (COVID-19) Data Report Form.docx	Coronavirus 2019 (COVID-19) Data Report Form.docx		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	Attachment B - 2020_CDR_Instruction_Manual_08_03_20_508.pdf	11/15/2020

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