Information Collection

Burden to Agents, Brokers, and Web-brokers to Respond to Notices of Intent to Terminate, of Temporary Suspension, and of Termination of FFE Agreements

IC 246291 under ICR 202408-0938-040 · OMB 0938-1349.

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Information Collection (IC) Details

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IC Title:

Burden to Agents, Brokers, and Web-brokers to Respond to Notices of Intent to Terminate, of Temporary Suspension, and of Termination of FFE Agreements

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.220(g)(3)(i) 45 CFR 155.220(g)(5)(i)(A)

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

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 42

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: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	42	42
Annual IC Time Burden (Hours)	420	420
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.