Information Collection

Fgd

IC 256696 under ICR 202210-0906-004 · OMB 0906-0074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0074 can be found here:

Documents and Forms

Document Name Document Type
Attachment B7 - PMHCA Champion FGD - Copy.docx Other-
Attachment B7 - PMHCA Champion FGD - Copy.docx Other-
Attachment B8 - MDRBD Champion FGD - Copy.docx Other-
Attachment B8 - MDRBD Champion FGD - Copy.docx Other-

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	FGD	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-			Attachment B7 - PMHCA Champion FGD - Copy.docx		Yes	Yes	Fillable Fileable
Other-			Attachment B8 - MDRBD Champion FGD - Copy.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 52

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	52	52
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.