Information Collection

Burdens and Economic Impacts of Medical Care SAQ

IC 269113 under ICR 202603-0935-001 · OMB 0935-0118.

Documents and Forms

Document Name Document Type
Form 63 Burdens and Economic Impacts of Medical Care SAQ Burdens and Economic Impacts of Medical Care SAQ Form and Instruction
63 Burdens and Economic Impacts of Medical Care SAQ Attachment 63 -- ESAQ.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Burdens and Economic Impacts of Medical Care SAQ	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	63	Burdens and Economic Impacts of Medical Care SAQ	Attachment 63 -- ESAQ.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,170	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-8,085	8,085
Annual IC Time Burden (Hours)	-1,348	1,348
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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