Information Collection

BHPr Performance Report

IC 6345 under ICR 201110-0915-003 · OMB 0915-0061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0061 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 BHPr Performance Report	Form and Instruction
1 PRGCA Manual PRGCA_Manual Final 06082012.pdf	Form and Instruction
Programs Reporting _SS.docx Programs Reporting _SS	IC Document
Performance goals model.docx Performance goals model	IC Document

IC Title:

BHPr Performance 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	PRGCA Manual	PRGCA_Manual Final 06082012.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,300

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,300	1,200	1,100
Annual IC Time Burden (Hours)	13,600	4,250	9,350
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Programs Reporting _SS	Programs Reporting _SS.docx	06/13/2012
Performance goals model	Performance goals model.docx	06/13/2012

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