SURVEY INSTRUMENT FOR HEALTH PLANNING PERFORMANCE EVALUATION PROGRAM

ICR 198008-0935-002

OMB: 0935-0022

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0935-0022 198008-0935-002
Historical Active 198008-0935-001
HHS/AHRQ
SURVEY INSTRUMENT FOR HEALTH PLANNING PERFORMANCE EVALUATION PROGRAM
Revision of a currently approved collection   No
Regular
Approved without change 08/12/1980
Retrieve Notice of Action (NOA) 08/04/1980
  Inventory as of this Action Requested Previously Approved
05/31/1981 05/31/1981 05/31/1981
40 0 40
120 0 120
0 0 0

THE SURVEY WILL COLLECT INFORMATION ON THE IMPACT/OF HEALTH SYSTEMS AGENCIES (HSAS) IN IMPROVING THE AVAILABILITY AND ACCESSIBILITY OF PRIMARY CARE AND ON THE STRATEGIES AND METHODS EMPLOYED BY HSAS IN ACHIEVING DESIRED CHANGES. INFORMATION OBTAINED WILL DOCUMENT THE PROCESS BEING MADE BY THE HEALTH PLANNING PROGRAM AND WILL BE USED FOR PROGRAM MANAGEMENT, POLICY DEVELOPMENT, AND AS A BASIS FOR THE DEVELOPMENT OF TECHNICAL ASSISTANCE FOR THE HEALTH PLANNING AGENCIES

None
None


No

1
IC Title Form No. Form Name
SURVEY INSTRUMENT FOR HEALTH PLANNING PERFORMANCE EVALUATION PROGRAM

  Total Approved 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 40 40 0 0 0 0
Annual Time Burden (Hours) 120 120 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/04/1980


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