Information Collection

Assurance and Certification Requirements

IC 236662 under ICR 202302-0945-001 · OMB 0945-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0945-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0945-0008_Form for 88.4 HHS-690 - revJune19_2019.docx	Other-form
0945-0008_Form for 88.4 HHS-690 - revJune19_2019.docx	Other-form

IC Title:

Assurance and Certification Requirements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-form			0945-0008_Form for 88.4 HHS-690 - revJune19_2019.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 158,890

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	158,890	158,890
Annual IC Time Burden (Hours)	635,560	635,560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.