Information Collection

Individual Participant Record

IC 272954 under ICR 202605-0906-001 · OMB 0906-0108.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 IND-PAR_Updated 05122026 Individual Participant Record	Form and Instruction
1 IND-PAR_Updated 05122026 IND-PAR_Updated 05122026.pdf	Form and Instruction
IND-PAR_30 day_tracked_FINAL.docx IND-PAR Tracked Changes	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 59,576

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	59,576	59,576
Annual IC Time Burden (Hours)	16,086	16,086
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IND-PAR Tracked Changes		01/10/2025

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

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