COMMUNITY SERVICE ASSURANCE REPORT (HILL-BURTON)

ICR 198507-0990-002

OMB: 0990-0096

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
167034
Migrated
ICR Details
0990-0096 198507-0990-002
Historical Active 198312-0990-002
HHS/HHSDM
COMMUNITY SERVICE ASSURANCE REPORT (HILL-BURTON)
No material or nonsubstantive change to a currently approved collection   No
Emergency 07/25/1985
Approved with change 07/25/1985
Retrieve Notice of Action (NOA) 07/25/1985
  Inventory as of this Action Requested Previously Approved
09/30/1986 09/30/1986 09/30/1986
2,312 0 2,312
208,080 0 1,691,000
0 0 0

THE COMMUNITY SERVICE ASSURANCE REPORT PRESENTS INFORMATION ABOUT THE COMMUNITY SERVICE PROVIDED BY HILL-BURTON RECIPIENTS. THE PUBLIC HEAL SERVICE ACT (TITLE VI AND XVI) REQUIRES THAT THIS INFORMATION BE OBTAINED PERIODICALLY TO ENABLE ASSESSMENT OF THE COMPLIANCE OF RECIPIENT HEALTH FACILITIES WITH THEIR COMMUNITY SERVICE ASSURANCE.

None
None


No

1
IC Title Form No. Form Name
COMMUNITY SERVICE ASSURANCE REPORT (HILL-BURTON)

  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 2,312 2,312 0 0 0 0
Annual Time Burden (Hours) 208,080 1,691,000 0 208,080 -1,691,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
07/25/1985


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