Information Collection

ANE Program Specific Data Forms

IC 209293 under ICR 202109-0915-002 · OMB 0915-0375.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0375 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ANE Program Specific Data Forms	Form and Instruction
1 ANE Program Specific Data Forms.docx ANE Program Specific Data Forms.docx	Form and Instruction
1 ANE Program Specific Data Forms.docx ANE Program Specific Data Forms.docx	Form and Instruction

IC Title:

ANE Program Specific Data Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	1	ANE Program Specific Data Forms.docx	ANE Program Specific Data Forms.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 521

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	Previously Approved
Annual Number of Responses for this IC	521	285	236
Annual IC Time Burden (Hours)	3,647	1,995	1,652
Annual IC Cost Burden (Dollars)	0	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.