OMB
.report
Search
Site LOU
I Can Do It, You Can Do It
OMB: 0990-0463
IC ID: 231782
OMB.report
HHS/HHSDM
OMB 0990-0463
ICR 201710-0990-002
IC 231782
( )
Documents and Forms
Document Name
Document Type
ICDI LOU Template 2018.docx
Other-form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Site LOU
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
Other-form
ICDI LOU Template 2018.docx
Yes
Yes
Paper Only
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:
50
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
50
0
50
0
0
0
Annual IC Time Burden (Hours)
2
0
2
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.
