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Federal forms, ICRs, and supporting documents

Information Collection

42 CFR 50.604(b) or 45 CFR 94.4(e)(1) for Institutions (Disclosure)

IC 200592 under ICR 202204-0925-001 · OMB 0925-0417.

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

View Information Collection (IC)

42 CFR 50.604(b) or 45 CFR 94.4(e)(1) for Institutions (Disclosure)
 
No Modified
 
Mandatory
 
42 CFR 50.604(b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attach 2- Instructions (3) (3).docx No   Paper Only

Health Public Health Monitoring

 

2,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 12,000 0 0 0 0 12,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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