Information Collection

Attachment H_PSO Change of Listing Information

IC 213835 under ICR 202512-0935-001 · OMB 0935-0143.

Documents and Forms

Document Name Document Type
Form Form 6 Attachment H_PSO Change of Listing Information Form and Instruction
Form Form 6 PSO Change of Listing Information Attachment H_PSO Change of Listing Information Form and Instruction
Form 6 PSO Change of Listing Information Attachment H_DRAFT_PSO Change of Listing Information Form.docx Form and Instruction
Form 6 PSO Change of Listing Information Attachment H_DRAFT_PSO Change of Listing Information Form.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment H_PSO Change of Listing Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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 and Instruction	Form 6	PSO Change of Listing Information	Attachment H_DRAFT_PSO Change of Listing Information Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	4	4
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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