Information Collection

Domestic Annual Report

IC 237702 under ICR 202506-0925-002 · OMB 0925-0765.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Domestic Annual Report	Form and Instruction
Form 2 Domestic Annual Report Domestic Annual Report	Form and Instruction
2 Domestic Annual Report Domestic Annual Report.docx	Form and Instruction
2 Domestic Annual Report Domestic Annual Report.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2				Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 890

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	890	890
Annual IC Time Burden (Hours)	1,335	1,335
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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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