View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Registration Contact Information Form	Agency IC Tracking Number:	0920-25-0073

Is this a Common Form? No		IC Status: Modified

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	0920-24DF	Registration Contact Information Form English	Att 4b_Registration Contact Information Form English_clean.docx		Yes	Yes	Fillable Fileable
Form	0920-24DF	Registration Contact Information Form Spanish	Att 4b_Registration Contact Information Form Spanish_clean.docx		Yes	Yes	Fillable Fileable
Form	0920-25-0073	Reg Contact Info Form English	Att 4b_Reg Contact Info Form Eng_clean.docx		Yes	Yes	Fillable Fileable
Form	0920-25-0073	Reg Contact Info Form Spanish	Att 4b_Registration Contact Info Form Spanish_clean.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 425	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	425	0	0	0	0	425
Annual IC Time Burden (Hours)	35	0	0	0	0	35
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.