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Program Facilitators- Fidelity log
Components Study of REAL Essentials
OMB: 0990-0480
IC ID: 248508
OMB.report
HHS/HHSDM
OMB 0990-0480
ICR 202207-0990-004
IC 248508
( )
Documents and Forms
Document Name
Document Type
Instrument 4_Fidelity Log832021.docx
Other-instruction and log
Instrument 4_Fidelity Log832021.docx
Other-instruction and log
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Program Facilitators- Fidelity log
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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-instruction and log
Instrument 4_Fidelity Log832021.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
13
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
312
0
0
0
0
312
Annual IC Time Burden (Hours)
52
0
0
0
0
52
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.