Information Collection

PEPFAR Program Expenditures

IC 264655 under ICR 202401-1405-005 · OMB 1405-0208.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DS-4213 Reporting Form.xlsx	Other-Spreadsheet
DS-4213 Reporting Form.xlsx	Other-Spreadsheet

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-Spreadsheet			DS-4213 Reporting Form.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: DS-4213 Reporting Form

FR Citation: 89 FR 12302

Number of Respondents: 4,045

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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	4,045	565	3,480
Annual IC Time Burden (Hours)	68,765	15	68,750
Annual IC Cost Burden (Dollars)	0	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.