Information Collection

Provider Relief Fund (PRF) and American Rescue Plan Act Rural (ARP-R) Attestation Portal

IC 251209 under ICR 202201-0906-002 · OMB 0906-0069.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Provider Relief Fund (PRF) and American Rescue Plan Act Rural (ARP-R) Attestation Portal	Form
1 PRF and ARP-R Attestation and Application Screenshots.pp PRF and ARP-R Attestation and Application Screenshots.pptx	Form
1 PRF and ARP-R Attestation and Application Screenshots.pp PRF and ARP-R Attestation and Application Screenshots.pptx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	PRF and ARP-R Attestation and Application Screenshots.pptx	PRF and ARP-R Attestation and Application Screenshots.pptx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 380,000

Number of Respondents for Small Entity: 10,000

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	380,000	380,000
Annual IC Time Burden (Hours)	95,000	95,000
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.