Information Collection

Requests for Discretionary Certificates of Confidntiality

IC 258027 under ICR 202301-0910-012 · OMB 0910-0130.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0130 can be found here:

Documents and Forms

Document Name Document Type
42 USC 241.pdf Other-Statutory Authority
42 USC 241.pdf Other-Statutory Authority
0130 CoC Cures 2012 - Final Guidance 2020.pdf Other-Agency Guidance
0130 CoC Cures 2012 - Final Guidance 2020.pdf Other-Agency Guidance

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Requests for Discretionary Certificates of Confidntiality	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 21 CFR 50

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Statutory Authority			42 USC 241.pdf		Yes	Yes	Fillable Fileable
Other-Agency Guidance			0130 CoC Cures 2012 - Final Guidance 2020.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	28	28
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.