Information Collection

100-Day Post-TED

IC 237624 under ICR 202103-0915-003 · OMB 0915-0310.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0310 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 100-Day Post-TED	Form
4 Form 2450 R5 - CURRENT.pdf 100 day Post-TED 3/29/21 Form 2450 R5 - CURRENT.pdf	Form
4 Form 2450 R5 - CURRENT.pdf 100 day Post-TED 3/29/21 Form 2450 R5 - CURRENT.pdf	Form
4 R Form 2450 R6 - REDLINE.docx 100 day Post-TED 3/29/21 Form 2450 R6 - REDLINE.docx	Form
4 R Form 2450 R6 - REDLINE.docx 100 day Post-TED 3/29/21 Form 2450 R6 - REDLINE.docx	Form
9 Form 2900 R4 - CURRENT.pdf Form 2900 R4 - CURRENT.pdf	Form
9 Form 2900 R4 - CURRENT.pdf Form 2900 R4 - CURRENT.pdf	Form
9 R Form 2900 R5 - REDLINE.docx Form 2900 R5 - REDLINE.docx	Form
9 R Form 2900 R5 - REDLINE.docx Form 2900 R5 - REDLINE.docx	Form

IC Title:

100-Day Post-TED

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4	Form 2450 R5 - CURRENT.pdf 100 day Post-TED 3/29/21	Form 2450 R5 - CURRENT.pdf	Yes	Yes	Fillable Fileable
Form	4 R	Form 2450 R6 - REDLINE.docx 100 day Post-TED 3/29/21	Form 2450 R6 - REDLINE.docx	Yes	Yes	Fillable Fileable
Form	9	Form 2900 R4 - CURRENT.pdf	Form 2900 R4 - CURRENT.pdf	Yes	Yes	Fillable Fileable
Form	9 R	Form 2900 R5 - REDLINE.docx	Form 2900 R5 - REDLINE.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	9,600	9,600
Annual IC Time Burden (Hours)	8,160	8,160
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.