Information Collection

RWHAP UOB Tables Summary

IC 238609 under ICR 202304-0906-001 · OMB 0906-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 RWHAP UOB Tables Summary	Form
1 Part A UOB Table Part A Instrument.docx	Form
1 Part A UOB Table Part A Instrument.docx	Form
2 Part B UOB Table Part B Instrument.docx	Form and Instruction
2 Part B UOB Table Part B Instrument.docx	Form and Instruction

IC Title:

RWHAP UOB Tables Summary

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	1	Part A UOB Table	Part A Instrument.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Part B UOB Table	Part B Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 111

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	111	111
Annual IC Time Burden (Hours)	56	56
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.