Information Collection

General Data Use Statement and Progress Report

IC 262234 under ICR 202505-0925-003 · OMB 0925-0780.

Documents and Forms

Document Name Document Type
Form 1 General Data Use Statement and Progress Report Form
Form 1 Form General Data Use Statement and Progress Report Form
1 Form Attachment 1 General Data Use Statement and Progress Report -OMB Control Number 0925-0780.docx Form
1 Form Attachment 1 General Data Use Statement and Progress Report -OMB Control Number 0925-0780.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	General Data Use Statement and Progress Report	Agency IC Tracking Number:

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
Form	1	Form	Attachment 1 General Data Use Statement and Progress Report -OMB Control Number 0925-0780.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	1,800	1,800
Annual IC Cost Burden (Dollars)	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.

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