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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.