Information Collection

Data Files Submission

IC 237061 under ICR 202211-0935-001 · OMB 0935-0245.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0245 can be found here:

Documents and Forms

Document Name Document Type
Form 4 Data Files Submission Form and Instruction
4 Data Files Submission Attachment E Data Submission Emails_FINAL_11.26 .docx Form and Instruction
4 Data Files Submission Attachment E Data Submission Emails_FINAL_11.26 .docx Form and Instruction
60 Day FRN.pdf 60 Day Federal Register Notice IC Document
60 Day FRN.pdf 60 Day Federal Register Notice IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Data Files Submission	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
Form and Instruction	4	Data Files Submission	Attachment E Data Submission Emails_FINAL_11.26 .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
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
60 Day Federal Register Notice	60 Day FRN.pdf	07/23/2019

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