Information Collection

GDC Data Submission Request Form

IC 225740 under ICR 202604-0925-001 · OMB 0925-0752.

Documents and Forms

Document Name Document Type
Form 1 Request Form GDC Data Submission Request Form Form
1 Request Form Attachment 1 - GDC Data-submission-request-form.pdf Form
Attachment 4 - GDC-automatic-emails.pdf Email Correspondence IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	GDC Data Submission Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	Request Form	Attachment 1 - GDC Data-submission-request-form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	-100	200
Annual IC Time Burden (Hours)	25	-25	50
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Email Correspondence	Attachment 4 - GDC-automatic-emails.pdf	04/07/2026

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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