Information Collection

Donor

IC 43644 under ICR 202303-0930-002 · OMB 0930-0158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0158 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0930-0158 _2023_Fe Donor	Form and Instruction
0930-0158 _2023_Fe 0930-0158 _2023_FedCCF_PROOF 0930-0158 CCF_Tab D_2023_FedCCF_PROOF.pdf	Form and Instruction
0930-0158 _2023_Fe 0930-0158 _2023_FedCCF_PROOF 0930-0158 CCF_Tab D_2023_FedCCF_PROOF.pdf	Form and Instruction
0930-0158 CCF_TAB A_ Executive Orders _ 12564.pdf 0930-0158 CCF_TAB A_ Executive Orders _ 12564	IC Document
0930-0158 CCF_TAB A_ Executive Orders _ 12564.pdf 0930-0158 CCF_TAB A_ Executive Orders _ 12564	IC Document
0930-0158 CCF_Tab B_UrMG_2017.pdf 0930-0158 CCF_Tab B_UrMG_2017	IC Document
0930-0158 CCF_Tab B_UrMG_2017.pdf 0930-0158 CCF_Tab B_UrMG_2017	IC Document

IC Title:

Donor

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	0930-0158 _2023_FedCCF_PROOF	0930-0158 _2023_FedCCF_PROOF	0930-0158 CCF_Tab D_2023_FedCCF_PROOF.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,726,610

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,726,610	6,726,610
Annual IC Time Burden (Hours)	538,129	538,129
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0930-0158 CCF_TAB A_ Executive Orders _ 12564	0930-0158 CCF_TAB A_ Executive Orders _ 12564.pdf	03/21/2023
0930-0158 CCF_Tab B_UrMG_2017	0930-0158 CCF_Tab B_UrMG_2017.pdf	03/21/2023

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