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Federalwide Assurance (FWA)
Federalwide Assurance (FWA)
OMB: 0990-0278
IC ID: 10411
OMB.report
HHS/HHSDM
OMB 0990-0278
ICR 202304-0990-009
IC 10411
( )
Documents and Forms
Document Name
Document Type
Form 0990-0978
Federalwide Assurance (FWA)
Form
0990-0978 FWA Form
FWA Form.pdf
Form
0990-0978 FWA Form
FWA Form.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Federalwide Assurance (FWA)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
45 CFR 46
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
0990-0978
FWA Form
FWA Form.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
14,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
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
28,000
0
0
0
0
28,000
Annual IC Time Burden (Hours)
14,000
0
0
0
0
14,000
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
