Information Collection

Unit Activity Reporting

IC 219143 under ICR 202205-0990-006 · OMB 0990-0302.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0302 Tool 4_Unit Activity Reporting Module.docx	Other-Reporting Module
0990-0302 Tool 4_Unit Activity Reporting Module.docx	Other-Reporting Module

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Reporting Module					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 748

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,992	-564	3,556
Annual IC Time Burden (Hours)	748	-141	889
Annual IC Cost Burden (Dollars)	0	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.

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