Information Collection

Appendix_A_RUDI_Provider_Subrecipient_Survey

IC 263054 under ICR 202310-0906-001 · OMB 0906-0079.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Appendix_A_RUDI_Provider_Subrecipient_Survey	Form and Instruction
1 RUDI - Provider Survey Appendix_A_RUDI_Provider_Subrecipient_Survey.docx	Form and Instruction
1 RUDI - Provider Survey Appendix_A_RUDI_Provider_Subrecipient_Survey.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Form and Instruction	1	RUDI - Provider Survey	Appendix_A_RUDI_Provider_Subrecipient_Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,066

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,066	1,066
Annual IC Time Burden (Hours)	352	352
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.