Consolidated Federal Financial Report (FFR)

DATA Act Section 5 Grants Pilot

Documents and Forms

Document Name Document Type
HHS DAP_Consolidated FFR Survey_May2016_051116.docx Other-Survey
CFFR Form Completion Cover Email_051116.docx Cover Email IC Document
4040-0017_SupportingStatement A CFFR_051116.docx Supporting Statment A IC Document
4040-0017_Short Supporting Statement CFFR_051116.docx Supporting Statement IC Document
CFFR Form Completion Kickoff_051116.pptx Kickoff IC Document

Information Collection (IC) Details

IC Title:	Consolidated Federal Financial Report (FFR)	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-Survey			HHS DAP_Consolidated FFR Survey_May2016_051116.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 320	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	320	320
Annual IC Time Burden (Hours)	53	53
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cover Email	CFFR Form Completion Cover Email_051116.docx	05/11/2016
Supporting Statment A	4040-0017_SupportingStatement A CFFR_051116.docx	05/11/2016
Supporting Statement	4040-0017_Short Supporting Statement CFFR_051116.docx	05/11/2016
Kickoff	CFFR Form Completion Kickoff_051116.pptx	05/11/2016

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