Information Collection

Health Center Controlled Networks Progress Report

IC 182775 under ICR 201101-0915-004 · OMB 0915-0315.

Documents and Forms

Document Name Document Type
Form 001_HCCN_PR Health Center Controlled Networks Progress Report Form
001_HCCN_PR 001_HCCN_PR FINALProgress_Report_Template_Nov_5.doc Form
HCCN PIMS Grantee Manual_R 2 1.pdf Instructions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Center Controlled Networks Progress Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	001_HCCN_PR	001_HCCN_PR	FINALProgress_Report_Template_Nov_5.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 89	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	178	86	92
Annual IC Time Burden (Hours)	3,188	2,636	552
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Instructions	HCCN PIMS Grantee Manual_R 2 1.pdf	01/24/2011

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