Single Audit Focus Group

DATA Act Section 5 Grants Pilot

Documents and Forms

Document Name Document Type
OMB Control 4040-0017 Collection1 HHS DAP_Single Audit Questionnaire_03172016.docx Other-questionnaire
March25-4040-0017 Generic - Short Supporting Statement Single Audit.docx Short Supporting statement IC Document
March25-4040SA 2 SupportingStatementAforSingleAuditICRFinal.docx Support statement A IC Document
HHS DAP NGMA SA Guided Discussion_03232016.pptx Discussion Guide IC Document

Information Collection (IC) Details

IC Title:	Single Audit Focus Group	Agency IC Tracking Number:

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-questionnaire			OMB Control 4040-0017 Collection1 HHS DAP_Single Audit Questionnaire_03172016.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Short Supporting statement	March25-4040-0017 Generic - Short Supporting Statement Single Audit.docx	03/25/2016
Support statement A	March25-4040SA 2 SupportingStatementAforSingleAuditICRFinal.docx	03/25/2016
Discussion Guide	HHS DAP NGMA SA Guided Discussion_03232016.pptx	03/25/2016

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