Information Collection

Acknowledgeing the Receipt of a Transferred Voucher

IC 219018 under ICR 202501-0910-009 · OMB 0910-0822.

Documents and Forms

Document Name Document Type
0822_Guidance.docx Other-Guidance

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Acknowledgeing the Receipt of a Transferred Voucher	Agency IC Tracking Number:	CDER

Is this a Common Form? No		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
Other-Guidance			0822_Guidance.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 90 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-1	2
Annual IC Time Burden (Hours)	8	-8	16
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.