Information Collection

ICURE Registration Sessions 10 and 11

IC 243891 under ICR 202201-0925-002 · OMB 0925-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ICURE Registration Sessions 10 and 11	Form and Instruction
1 Registration Form ICARE Dialogues Registration with demographics supporting docs10_2020.pdf	Form and Instruction
1 Registration Form ICARE Dialogues Registration with demographics supporting docs10_2020.pdf	Form and Instruction
ICARE Dialogues Registration OMB application registration with demographics only Sessions 10 and 11.docx Template	IC Document
ICARE Dialogues Registration OMB application registration with demographics only Sessions 10 and 11.docx Template	IC Document

IC Title:

ICURE Registration Sessions 10 and 11

Agency IC Tracking Number:

IC Status: Unchanged

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	Registration Form	ICARE Dialogues Registration with demographics supporting docs10_2020.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template	ICARE Dialogues Registration OMB application registration with demographics only Sessions 10 and 11.docx	10/06/2020

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