Information Collection

Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Quality Improvement Instrument

IC 197495 under ICR 201204-0915-001 · OMB 0915-0344.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 008_Sickle Cell_QI 008_Sickle Cell_QI Instrument Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Quality Improvement Instrument	Form
008_Sickle Cell_QI 008_Sickle Cell_QI Instrument SCDTDP Quality Improvement Instrument.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	008_Sickle Cell_QI Instrument	008_Sickle Cell_QI Instrument	SCDTDP Quality Improvement Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9

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	Previously Approved
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	432	432
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.