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AmeriCorps NCCC Medical Form
AmeriCorps NCCC Medical Form
OMB: 3045-0183
IC ID: 223732
OMB.report
CNCS
OMB 3045-0183
ICR 201609-3045-002
IC 223732
( )
Documents and Forms
Document Name
Document Type
Form 1
AmeriCorps NCCC Medical Form
Form and Instruction
1 AmeriCorps NCCC Medical Form
NCCC MMHIF PDF 12.2016.pdf
www.nationalservice.gov
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
AmeriCorps NCCC Medical Form
Agency IC Tracking Number:
Is this a Common Form?
No
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
Form and Instruction
1
AmeriCorps NCCC Medical Form
NCCC MMHIF PDF 12.2016.pdf
www.nationalservice.gov
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
8,500
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
8,500
0
8,500
0
0
0
Annual IC Time Burden (Hours)
2,125
0
2,125
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.