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Federal forms, ICRs, and supporting documents

Information Collection

Family-to-Family Health Information Centers Data Submission Form

IC 234424 under ICR 202201-0906-001 · OMB 0906-0040.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Family-to-Family Health Information Centers Data Submission Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Data Submission Final clean.docx FORM - Data Submission Final clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

59 59
   
Private Sector Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 59 0 0 0 0 59
Annual IC Time Burden (Hours) 5,251 0 0 0 0 5,251
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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