Information Collection

Healthcare Provider (Profit/Non-Profit Business)

IC 205111 under ICR 202109-0584-001 · OMB 0584-0580.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0580 can be found here:

Documents and Forms

Document Name Document Type
App_H1.Year 9 HW measurement card - English.docx Other-App_H1.Year 9 HW measurement c
App_H1.Year 9 HW measurement card - English.docx Other-App_H1.Year 9 HW measurement c
App_H2.Year 9 HW measurement card - Spanish.docx Other-App_H2.Year 9 HW measurement c
App_H2.Year 9 HW measurement card - Spanish.docx Other-App_H2.Year 9 HW measurement c

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Healthcare Provider (Profit/Non-Profit Business)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-App_H1.Year 9 HW measurement card - English			App_H1.Year 9 HW measurement card - English.docx		No		Paper Only
Other-App_H2.Year 9 HW measurement card - Spanish			App_H2.Year 9 HW measurement card - Spanish.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: FNS-8 USDA/FNS Studies and Reports	FR Citation: 56 FR 19078

Number of Respondents: 428	Number of Respondents for Small Entity: 171

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, 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	428	-423	851
Annual IC Time Burden (Hours)	71	-71	142
Annual IC Cost Burden (Dollars)	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.