Information Collection

Healthcare System Stress Pulse

IC 210556 under ICR 201203-0990-001 · OMB 0990-0391.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0391 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
21497 ID_0990-0391USCIITG Pulse - DHSP REVISED Draft Queery 26Feb2014.docx	Other-survey
21497 ID_HPP CLEARNANCE HEALTHCARESYSTEMSTRESS DHSP finaledit.doc 21497 ID_HPP CLEARNANCE HEALTHCARESYSTEMSTRESS DHSP finaledit	IC Document

IC Title:

Healthcare System Stress Pulse

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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
Other-survey			21497 ID_0990-0391USCIITG Pulse - DHSP REVISED Draft Queery 26Feb2014.docx		No	No	Printable Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	90	0	0	0	0	0
Annual IC Time Burden (Hours)	15	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
21497 ID_HPP CLEARNANCE HEALTHCARESYSTEMSTRESS DHSP finaledit	21497 ID_HPP CLEARNANCE HEALTHCARESYSTEMSTRESS DHSP finaledit.doc	02/28/2014

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