OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Attachment 19 – HC Adult SAQ – Male

IC 230227 under ICR 202209-0935-003 · OMB 0935-0118.

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

View Information Collection (IC)

Attachment 19 – HC Adult SAQ – Male
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment 19 Attachment 19 – HC Adult SAQ – Male Attachment 19 HC Adult SAQ Male.docx No   Paper Only
Form and Instruction Attachment 18 Attachment 18 HC Adult SAQ Attachment 18 HC Adult SAQ.pdf No   Paper Only

Health Health Care Services

 

11,985 0
   
Individuals or Households
 
   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 11,985 0 0 0 0 11,985
Annual IC Time Burden (Hours) 1,398 0 0 0 0 1,398
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.