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Health Systems Agency Application For Designation, Grant Applications And Related Report Forms
HEALTH SYSTEMS AGENCY APPLICATION FOR DESIGNATION, GRANT APPLICATIONS AND RELATED REPORT FORMS
OMB: 0935-0017
IC ID: 165968
OMB.report
HHS/AHRQ
OMB 0935-0017
ICR 198106-0935-003
IC 165968
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HEALTH SYSTEMS AGENCY APPLICATION FOR DESIGNATION, GRANT APPLICATIONS AND RELATED REPORT FORMS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
217-1
No
No
Form
217-2
No
No
Form
217-3
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
204
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
204
0
0
0
0
204
Annual IC Time Burden (Hours)
13,260
0
0
0
0
13,260
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.