Information Collection

Health Center Controlled Networks Progress Report

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.