Information Collection

RWHAP UOB Tables Summary

IC 238609 under ICR 202601-0906-001 · OMB 0906-0047.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Part A UOB Table RWHAP UOB Tables Summary	Form
Form 1 Part A UOB Table RWHAP UOB Tables Summary	Form
Form 2 Part B UOB Table RWHAP UOB Tables Summary	Form and Instruction
Form 2 Part B UOB Table RWHAP UOB Tables Summary	Form and Instruction
1 Part A UOB Table Part A Instrument_Final 12 10 2025.docx	Form
1 Part A UOB Table Part A Instrument_Final 12 10 2025.docx	Form
2 Part B UOB Table Part B Instrument_Final 12 10 2025.docx	Form and Instruction
2 Part B UOB Table Part B Instrument_Final 12 10 2025.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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	1				Yes	Yes	Fillable Fileable
Form and Instruction	2				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 111

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	111	111
Annual IC Time Burden (Hours)	56	56
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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