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Federal forms, ICRs, and supporting documents

Information Collection

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IC 269999 under ICR 202409-0990-001 · OMB 0990-0379.

Documents and Forms
Document Name
Document Type
Other-Survey
Other-Survey
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Language Assistance Symbol
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey LAS Survey 8-8-2024.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,000 0
   
Individuals or Households
 
   100 %

  Requested 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 1,000 0 0 0 0 1,000
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
memo MEMO_FastTrack Generic Clearance Submission LAS August 6 2024.docx 08/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.