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Emergency Significant Incident Report (Form A-10A)

IC 241074 under ICR 202301-0970-008 · OMB 0970-0547.

Documents and Forms
Document Name
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Information Collection (IC) Details

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Emergency Significant Incident Report (Form A-10A)
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form A-10A Emergency Significant Incident Report - UC Path Version Emergency SIR and Addendum (Form A-10A) - UC Path.pdf Yes Yes Fillable Fileable
Form A-10A Emergency SIR and Addendum - UC Portal Version Emergency SIR and Addendum (Form A-10A) - UC Portal.pdf Yes Yes Fillable Fileable

Community and Social Services Social Services

 

216 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 3,024 0 0 0 0 3,024
Annual IC Time Burden (Hours) 3,024 0 0 0 0 3,024
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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