Information Collection

Certificate of Compliance w/42 CFR part 11

IC 257032 under ICR 202602-0910-004 · OMB 0910-0231.

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Information Collection (IC) Details

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IC Title:	Certificate of Compliance w/42 CFR part 11	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 11

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	61	21	40
Annual IC Time Burden (Hours)	46	16	30
Annual IC Cost Burden (Dollars)	0	0	0

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