Information Collection

Application for Small Business

IC 244201 under ICR 202401-0925-003 · OMB 0925-0767.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0767 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Application for Small Business Form
1 Application PEI Application-BusinessPartner_final.pdf Form
1 Application PEI Application-BusinessPartner_final.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Small Business	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Application	PEI Application-BusinessPartner_final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0156 âRecords of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD	FR Citation: 67 FR 60765

Number of Respondents: 43	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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	43	37	6
Annual IC Time Burden (Hours)	32	27	5
Annual IC Cost Burden (Dollars)	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.