Delta States Rural Development Network Grant Program

Rural Health Community-Based Grant Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0319 can be found here:

Documents and Forms

Document Name Document Type
Form 3 Delta States Rural Development Network Grant Program Form and Instruction
3 Delta States Rural Development Network Delta States Program PIMS Measures--FINAL.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Delta States Rural Development Network Grant Program	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 and Instruction	3	Delta States Rural Development Network	Delta States Program PIMS Measures--FINAL.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12	0	12
Annual IC Time Burden (Hours)	37	22	15
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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