Information Collection

Set-up Fee Questionnaire (H/C staff) (Survey year: 2024)

IC 256557 under ICR 202412-0920-002 · OMB 0920-0234.

Documents and Forms

Document Name Document Type
Form 0920-0234 Set-up Fee Questionnaire (H/C staff) (Survey year: 2024) Form and Instruction
0920-0234 Set-up Fee Questionnaire (2024) Attachment K_HC Set-up Fee Questionnaire.pdf Form and Instruction
0920-0234 Set-up Fee Questionnaire (2024) Attachment K_HC Set-up Fee Questionnaire.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Set-up Fee Questionnaire (H/C staff) (Survey year: 2024)	Agency IC Tracking Number:	0920-0234

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0234	Set-up Fee Questionnaire (2024)	Attachment K_HC Set-up Fee Questionnaire.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	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: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	17	-183	200
Annual IC Time Burden (Hours)	4	-46	50
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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