Information Collection Request

ARRA Section 3012 Supporting Statement for State Health Information Exchange Cooperative Agreement Program

ICR 200908-0990-010 · OMB 0990-0340 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 Preliminary Application Data Request Form and Instruction Unchanged Available
Justification for a Nonsubs. Change for 0990-0340.doc Justification for No Material/Nonsubstantive Change Uploaded 2009-08-31 Available
Rev to 0990-0299 Emergency Request Form. Prelim App 083109 V6.xls Supplementary Document Uploaded 2009-08-31 Available
3012 PRA SS A.doc Supporting Statement A Uploaded 2009-08-19 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
190359 Preliminary Application Data Request Form and Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2010 02/28/2010 02/28/2010
300 0 300
42,000 0 42,000
0 0 0





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1
table that charts list of burden
IC Title Form No. Form Name
Preliminary Application Data Request 1 Prelimnary Data Request

table that charts list of burden
  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 300 300 0 0 0 0
Annual Time Burden (Hours) 42,000 42,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No