Information Collection

TCH Registration Form

IC 219104 under ICR 202603-0990-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0407_Attachment B_Registration (SEPT 2026).docx thinkculturalhealth.hhs.gov/	Other-Registration

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Registration				https://thinkculturalhealth.hhs.gov/	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 118,352

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	118,352	108,892	9,460
Annual IC Time Burden (Hours)	5,918	5,445	473
Annual IC Cost Burden (Dollars)	0	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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