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Federal forms, ICRs, and supporting documents

Information Collection

Primary Data Coordinator Form

IC 256997 under ICR 202502-0915-003 · OMB 0915-0184.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Primary Data Coordinator Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 19 Primary Data Coordinator Primary Data Coordinator Form.docx Yes Yes Fillable Fileable
Form and Instruction 19R (03.25 version) Primary Data Coordinator Form R_HSB_0915-0184_Primary Data Coordinator Form REDLINE.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,760 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 53 0 0 0 0 53
Annual IC Time Burden (Hours) 7 0 0 0 0 7
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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