Information Collection

RFCC Leaders Director/Program Coordinator Questionnaire

IC 180719 under ICR 200706-0990-003 · OMB 0990-0316.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-Appendix D_RFCC	Other-questionnaire
0990-Appendix H RFCC.doc 0990-Appendix H RFCC	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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-questionnaire					No	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	11	11
Annual IC Time Burden (Hours)	22	22
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-Appendix H RFCC		06/07/2007

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

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