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OCR Pre-granted Automation Project
OCR Pre-granted Automation Project
OMB: 0990-0243
IC ID: 10370
OMB.report
HHS/HHSDM
OMB 0990-0243
ICR 201102-0990-001
IC 10370
( )
Documents and Forms
Document Name
Document Type
Form 1
OCR Pre-granted Automation Project
Form
1 0990-0243-Civil Rights Infomation Request Form RevDS8-9-
0990-0243-Civil Rights Infomation Request Form RevDS8-9-10[2].doc
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
OCR Pre-granted Automation Project
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
45 CFR 80
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
0990-0243-Civil Rights Infomation Request Form RevDS8-9-10[2]
0990-0243-Civil Rights Infomation Request Form RevDS8-9-10[2].doc
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:
2,900
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
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
2,900
0
2,900
0
0
0
Annual IC Time Burden (Hours)
23,200
0
23,200
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.
