Information Collection

Evaluation of the Implementation and Impact of Pay-for-Quality Programs

IC 178812 under ICR 200702-0935-003 · OMB 0935-0130.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SNAP P4Q Supporting Documents - Appendix.doc	Other-Other
Interview Protocol Revised 6-19.doc Interview Protocol Revised 6-19	IC Document
Survey Instrument - BMC Version Revised 6-19.doc Survey Instrument - BMC Version Revised 6-19	IC Document
Survey Instrument - Montefiore Version Revised 6-19.doc Survey Instrument - Montefiore Version Revised 6-19	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.6

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other			SNAP P4Q Supporting Documents - Appendix.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 240

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	114	114
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Interview Protocol Revised 6-19	Interview Protocol Revised 6-19.doc	06/28/2007
Survey Instrument - BMC Version Revised 6-19	Survey Instrument - BMC Version Revised 6-19.doc	06/28/2007
Survey Instrument - Montefiore Version Revised 6-19	Survey Instrument - Montefiore Version Revised 6-19.doc	06/28/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.