Information Collection

43 CFR 482.59(b) and (c)

IC 271649 under ICR 202410-0938-011 · OMB 0938-0328.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0328 can be found here:

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Information Collection (IC) Details

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IC Title:	43 CFR 482.59(b) and (c)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 43 CFR 482.59(b) and (c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 999	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	999	999
Annual IC Time Burden (Hours)	39,960	39,960
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.