View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Attendee Registration Form for the Indian Health Service (IHS) Third Party Billing and Accounts Receivable Training	Agency IC Tracking Number:	101

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 and Instruction	0917-0036-101	Registration	TPB-AR registration form.07-15-22.pdf		Yes	Yes	Fillable Fileable

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: 75	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	75	0	75	0	0	0
Annual IC Time Burden (Hours)	6	0	6	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Submission Template	Request Approval.Registration Form.ORAP_07-15-22.docx	07/21/2022

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