Information Collection

Healthcare Provider (Profit/Non-Profit Business)

IC 205111 under ICR 202204-0584-005 · OMB 0584-0580.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App_H1.Year 9 HW measurement card - English.docx	Other-App_H1.Year 9 HW measurement c
App_H1.Year 9 HW measurement card - English.docx	Other-App_H1.Year 9 HW measurement c
App_H2.Year 9 HW measurement card - Spanish.docx	Other-App_H2.Year 9 HW measurement c
App_H2.Year 9 HW measurement card - Spanish.docx	Other-App_H2.Year 9 HW measurement c

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Other-App_H1.Year 9 HW measurement card - English			App_H1.Year 9 HW measurement card - English.docx		No		Paper Only
Other-App_H2.Year 9 HW measurement card - Spanish			App_H2.Year 9 HW measurement card - Spanish.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 428

Number of Respondents for Small Entity: 171

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	428	428
Annual IC Time Burden (Hours)	71	71
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.