OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Hhs 568

IC 217415 under ICR 202408-0925-003 · OMB 0925-0002.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 1
HHS 568		 Form
1 Form
Attachment 15_hhs568.docx 		Form
1 Form
Attachment 15_hhs568.docx 		Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 1 Form Attachment 15_hhs568.docx Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11,180 0 0 0 0 11,180
Annual IC Time Burden (Hours) 932 0 0 0 0 932
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.