Delinquent Audit Follow-up Email and Attestation

COVID–19 Provider Relief Programs Single and Commercial Audits and Delinquent Audit Reporting Submission Activities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0083 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Delinquent Audit Follow-up Email and Attestation Form and Instruction
2 Delinquent Audit Follow-up Email and Attestation Delinquent Audit Follow-Up Targeted Email_Final.docx Form and Instruction
2 Revised Delinquent Audit Follow-up Attestation Form Delinquent Audit Follow-Up Attestation Form_Final Revised 3-15-24 Clean.docx Form and Instruction
2 Revised Delinquent Audit Follow-up Attestation Form_Redl Delinquent Audit Follow-Up Attestation Form_Final Revised 3-15-24 Track Changes.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Delinquent Audit Follow-up Email and Attestation	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Delinquent Audit Follow-up Email and Attestation	Delinquent Audit Follow-Up Targeted Email_Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Revised Delinquent Audit Follow-up Attestation Form	Delinquent Audit Follow-Up Attestation Form_Final Revised 3-15-24 Clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Revised Delinquent Audit Follow-up Attestation Form_Redline	Delinquent Audit Follow-Up Attestation Form_Final Revised 3-15-24 Track Changes.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	42,000	42,000
Annual IC Time Burden (Hours)	10,500	10,500
Annual IC Cost Burden (Dollars)	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.