Hill-Burton Community Service Assurance Report Triennial IV

ICR 199503-0990-001

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
ICR Details
0990-0096 199503-0990-001
Historical Active 199309-0990-001
HHS/HHSDM
Hill-Burton Community Service Assurance Report Triennial IV
Extension without change of a currently approved collection   No
Regular
Approved without change 06/05/1995
Retrieve Notice of Action (NOA) 03/27/1995
  Inventory as of this Action Requested Previously Approved
12/31/1995 12/31/1995 06/30/1995
2,100 0 0
110,250 0 110,250
0 0 0

The Community Service Assurance Report presents information about community service provided by Hill-Burton recipients. The Public Health Service Act (Titles 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
Hill-Burton Community Service Assurance Report Triennial IV OS/OCR-541

  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 2,100 0 0 2,100 0 0
Annual Time Burden (Hours) 110,250 110,250 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.
03/27/1995


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