Information Collection

TCH Registration Form

IC 219104 under ICR 202208-0990-001 · OMB 0990-0407.

Documents and Forms

Document Name Document Type
Appendix B - TCH User Registration Form (12.2.15).pdf Other-form
Appendix B - TCH User Registration Form (12.2.15).pdf Other-form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TCH Registration Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-form			Appendix B - TCH User Registration Form (12.2.15).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,460	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	9,460	9,460
Annual IC Time Burden (Hours)	473	473
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.