Information Collection

RPPR (or 2590 or 416-9)

IC 7244 under ICR 201306-0925-005 · OMB 0925-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0002 can be found here:

Documents and Forms

Document Name Document Type
Attachment 4 - PHS 2590 Instructions.docx Instruction
Attachment 6 - PHS 416-9 Instructions.docx Instruction
1 PHS 2590 Attachment 3 - PHS 2590 forms.pdf Form
2 PHS 416-9 Attachment 5 - PHS 416-9 forms.pdf Form and Instruction
3 RPPR Attachment 7 - RPPR Screen Shots.pdf Form
Attachment 8 - RPPR Instruction Guide.docx Attachment 8 - RPPR Instruction Guide IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	RPPR (or 2590 or 416-9)	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment 4 - PHS 2590 Instructions.docx	Yes	Yes	Fillable Fileable
Form	1	PHS 2590	Attachment 3 - PHS 2590 forms.pdf	Yes	Yes	Fillable Printable
Form and Instruction	2	PHS 416-9	Attachment 5 - PHS 416-9 forms.pdf	Yes	Yes	Fillable Fileable
Instruction			Attachment 6 - PHS 416-9 Instructions.docx	Yes	Yes	Fillable Fileable
Form	3	RPPR	Attachment 7 - RPPR Screen Shots.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	41,000	431	40,569
Annual IC Time Burden (Hours)	615,035	6,500	608,535
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 8 - RPPR Instruction Guide	Attachment 8 - RPPR Instruction Guide.docx	06/28/2012

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