Information Collection

Federalwide Assurance (FWA)

IC 10411 under ICR 202501-0990-001 · OMB 0990-0278.

Documents and Forms

Document Name Document Type
Form 0990-0278 Federalwide Assurance (FWA) Form
0990-0278 Federalwide Assurance (FWA) FWA Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Federalwide Assurance (FWA)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 46

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0990-0278	Federalwide Assurance (FWA)	FWA Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,000	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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,000	-15,000	28,000
Annual IC Time Burden (Hours)	4,290	-9,710	14,000
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.