Letter of Intent

ARRA Section 3013 Supporting Statement for State Health Information Exchange Cooperative Agreement Program

OMB: 0990-0339

IC ID: 190358

Documents and Forms
Information Collection (IC) Details

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Letter of Intent
 
  New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 LOI Attachment to 3013-Letter of Intent.doc Yes No Printable Only

Health Health Care Services

 

50 0
   
State, Local, and Tribal Governments
 
   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 50 0 50 0 0 0
Annual IC Time Burden (Hours) 500 0 500 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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