View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	IZ CORE	Agency IC Tracking Number:	15CB

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
Other-WORD			Att. A Interview Guide.docx		No		Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 64	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	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	64	0	64	0	0	0
Annual IC Time Burden (Hours)	64	0	64	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	IZ-CORE-SSA.docx	12/10/2014
Supporting Statement B	IZ-CORE-SSB.docx	12/10/2014
Attachment B_Invitation and Overview	Att. B Invitation and Overview.docx	12/10/2014
Attachment C_ Reminder E-mail	Att. C Reminder Email.docx	12/10/2014
Attachment D_Confirmation	Att. D Confirmation.docx	12/10/2014
Attachment E_Thank You Email	Att. E Thank You Email.docx	12/10/2014

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