View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

My Mobility Product Testing Activities 0920-1050-22IH
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1050 No   Fillable Fileable
Instruction No   Paper Only
Instruction No   Paper Only
Other-WORD No   Fillable Fileable Signable

Health Consumer Health and Safety

 

320 0
   
Individuals or Households
 
   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 320 0 320 0 0 0
Annual IC Time Burden (Hours) 108 0 108 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1050) 08/16/2022
My Mobility Plan (English) 08/16/2022
My Mobility Plan Spanish 08/16/2022
My Mobility Plan_Tribal 08/16/2022
Medicine Fact Sheet (English) 08/16/2022
Medicine Fact Sheet (Spanish) 08/16/2022
Medicine Fact Sheet (Tribal) 08/16/2022
MyMedications List (English) 08/16/2022
MyMedications List (Spanish 08/16/2022
MyMedications LIst (Tribal) 08/16/2022
MyMedications Action Plan (English) 08/16/2022
MyMedications Action Plan (Spanish) 08/16/2022
MyMedications Action Plan (Tribal) 08/16/2022
My Mobility PIA 08/16/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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