View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	471 HealthIT+qnaire+for+dataload+final;472CQs for OMB started 7-8-2011; 473 SSA iClaim v2	Agency IC Tracking Number:	471-473

IC Status: New

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	471 HealthIT+qnaire+for+dataload+final	471 HealthIT+qnaire+for+dataload+final	2011 471 Copy of HealthIT+qnaire+for+dataload+final.xlsx		Yes	Yes	Fillable Fileable
Form	472 CQs for OMB started 7-8-2011	472 CQs for OMB started 7-8-2011	2011 472 CQs for OMB started 7-8-2011.xlsx		Yes	Yes	Fillable Fileable
Form	473 SSA iClaim v2	473 SSA iClaim v2	2011 473 SSA iClaim v2.xlsx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	15,000	0	15,000	0	0	0
Annual IC Time Burden (Hours)	625	0	625	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

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.