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COVID-19 Provider Relief Fund (PRF) Reporting Activities
COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Payment Reporting Activities
OMB: 0906-0068
IC ID: 250697
OMB.report
HHS/HRSA
OMB 0906-0068
ICR 202210-0906-003
IC 250697
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0068 can be found here:
2023-05-11 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
COVID-19 Provider Relief Fund (PRF) Reporting Activities
Form
1 Data Form Elements
PRF Reporting Activities - 4 Data Form Elements.xlsx
Form
1 Data Form Elements
PRF Reporting Activities - 4 Data Form Elements.xlsx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
COVID-19 Provider Relief Fund (PRF) Reporting Activities
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
Data Form Elements
PRF Reporting Activities - 4 Data Form Elements.xlsx
Yes
Yes
Fillable Fileable
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:
308,029
Number of Respondents for Small Entity:
49,494
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
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
308,029
0
0
0
0
308,029
Annual IC Time Burden (Hours)
1,556,212
0
0
0
0
1,556,212
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.