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Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Quality Improvement Instrument
Sickle Cell Disease Program Evaluations
OMB: 0915-0344
IC ID: 197495
OMB.report
HHS/HSA
OMB 0915-0344
ICR 201204-0915-001
IC 197495
( )
Documents and Forms
Document Name
Document Type
Form 008_Sickle Cell_QI
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - Quality Improvement Instrument
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection 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
Federal Enterprise Architecture Business Reference Module
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 %
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
108
0
0
0
0
108
Annual IC Time Burden (Hours)
432
0
0
0
0
432
Annual IC Cost Burden (Dollars)
0
0
0
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.
