Information Collection

Notice Requirements

IC 255335 under ICR 202208-0945-001 · OMB 0945-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0945-0011 can be found here:

Documents and Forms

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IC Title:

Notice Requirements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 84 45 CFR 85 45 CFR 86 45 CFR 80 45 CFR 90 45 CFR 91

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 275,002

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	275,002	275,002
Annual IC Time Burden (Hours)	481,254	481,254
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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