View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Donor	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Federal CCF	Federal CCF	Att D 2013_FedCCF_PROOFtoHHS_130730 Final.pdf		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,150,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	6,150,000	0	0	-946,000	0	7,096,000
Annual IC Time Burden (Hours)	512,500	0	0	-55,180	0	567,680
Annual IC Cost Burden (Dollars)	0	0	0	-2,212,000	0	2,212,000

Documents for IC

Title	Document	Date Uploaded
FR MG effective date final	Att C FR MG effective date final.pdf	07/16/2013
Executive Order 12564	Att A Executive Order 12564.pdf	07/16/2013
FR MG 2008	Att B FR MG 2008.pdf	07/16/2013

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