Information Collection

GDC Data Submission Request Form

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

Documents and Forms

Documents and forms in this information collection
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

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
Form	1				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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Email Correspondence		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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