Information Collection

ANE Program Specific Form

IC 209293 under ICR 202111-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Form 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 Form	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	Previously Approved
Annual Number of Responses for this IC	521	521
Annual IC Time Burden (Hours)	3,647	3,647
Annual IC Cost Burden (Dollars)	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.