Information Collection

Early Payor Feedback Program (EPFP)

IC 257633 under ICR 202212-0910-007 · OMB 0910-0756.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0756 can be found here:

Documents and Forms

Document Name Document Type
EPFP_OverviewDocument_Template.docx Other-Agency Template
EPFP_OverviewDocument_Template.docx Other-Agency Template

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Early Payor Feedback Program (EPFP)	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-Agency Template			EPFP_OverviewDocument_Template.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	60	60
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.