Forms and Documents

Document Name	Status
Form 1 Private sector Form and Instruction	Modified
Attachment 1 Update assurance statement NOV 2024_TrackChanged.docx Supplementary Document	2024-11-12
OMB change request NOV 4 2024.pdf Justification for No Material/Nonsubstantive Change	2024-11-12
Attachment 1 Updated assurance statement May 2024.docx Supplementary Document	2024-05-27
OMB change request May 2024.signed.pdf Justification for No Material/Nonsubstantive Change	2024-05-27
Revised assurance statement SEP2023.clean.docx Supplementary Document	2023-10-05
Markup assurance statement SEP2023.pdf Supplementary Document	2023-10-05
OMB change request SEP 2023.1signed.pdf Justification for No Material/Nonsubstantive Change	2023-10-04
Updated assurance statement 06022023.pdf Supplementary Document	2023-06-15
OMB change request JUN 2023.pk.pdf Justification for No Material/Nonsubstantive Change	2023-06-15
Change Request Memo.docx Justification for No Material/Nonsubstantive Change	2022-10-13
pub 30day FRN2022-05474.pdf Supplementary Document	2022-03-15
Attachment 2 - List of DHHS CoC Coordinators.docx Supplementary Document	2022-03-14
CoC Support_StatementA_FINAL_MAR2022.docx Supporting Statement A	2022-03-14
Attachment 3 - Privacy Impact Assessment (PIA) NOV 2021.pdf Supplementary Document	2022-03-14
Attachment 4 - NIH Privacy Act Memo Applicability of the Privacy Act_CoC_FEB 2022.pdf Supplementary Document	2022-03-14

IC Document Collections

IC ID	Document Title	Status
252166	Private sector Form and Instruction	Modified

ICR Details

OMB Control No:	ICR Reference No:
Status:	Previous ICR Reference No:
Agency/Subagency:	Agency Tracking No:
Title:
Type of Information Collection:	Common Form ICR:
Type of Review Request:	Date Received in OIRA:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract:

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR?

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Number of Information Collection (IC) in this ICR: 0

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ICR Summary of Burden

	Total	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	0	0	0	0	0	0
Annual Time Burden (Hours)	0	0	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion:

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion:

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods?

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.    

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.    

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?

Is this ICR related to the Pandemic Response?

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Common Form ICR: 

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date:

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