Information Collection

Language Assistance Symbol

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
LAS Survey 8-8-2024.docx	Other-Survey
LAS Survey 8-8-2024.docx	Other-Survey
MEMO_FastTrack Generic Clearance Submission LAS August 6 2024.docx memo	IC Document
MEMO_FastTrack Generic Clearance Submission LAS August 6 2024.docx memo	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

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
Other-Survey					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
memo		08/09/2024

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

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