Information Collection

Evaluation data for private-sector organizations

IC 199192 under ICR 202404-0920-004 · OMB 0920-0909.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0909 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0909 Evaluation data for private-sector organizations	Form and Instruction
0920-0909 Evaluation Data Form Att 4B Evaluation Data_OMB No. 0920-0909_09-27-23_final.xlsx	Form and Instruction
0920-0909 Evaluation Data Form Att 4B Evaluation Data_OMB No. 0920-0909_09-27-23_final.xlsx	Form and Instruction

IC Title:

Evaluation data for private-sector organizations

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	0920-0909	Evaluation Data Form	Att 4B Evaluation Data_OMB No. 0920-0909_09-27-23_final.xlsx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,160

Number of Respondents for Small Entity: 870

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	Previously Approved
Annual Number of Responses for this IC	2,320	-620	2,940
Annual IC Time Burden (Hours)	4,640	-1,240	5,880
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.