Information Collection

SRCP Partner Cost Survey

IC 235091 under ICR 201902-0920-018 · OMB 0920-1259.

Documents and Forms

Document Name Document Type
SRCP Partner Cost Survey Form and Instruction
SRCP Partner Cost Survey Att.2 Partner Cost Survey (SRCP).docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SRCP Partner Cost Survey	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	NA	SRCP Partner Cost Survey	Att.2 Partner Cost Survey (SRCP).docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 44	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 Agency Discretion
Annual Number of Responses for this IC	44	44
Annual IC Time Burden (Hours)	44	44
Annual IC Cost Burden (Dollars)	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.