Information Collection

Rural Health Information Technology Network Development

IC 202626 under ICR 201206-0915-003 · OMB 0915-0354.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0354 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Rural Health Information Technology Network Development	Form and Instruction
1 PIMS RHITND PIMS--response to OMB (7-20-12).docx	Form and Instruction
Outreach authority (2005).pdf Authority	IC Document
RHITND_Demographics.pdf RHITND_Demographics	IC Document
RHITND_Environment.pdf RHITND_Environment	IC Document

IC Title:

Rural Health Information Technology Network Development

Agency IC Tracking Number:

Is this a Common Form? No

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
Form and Instruction	1	PIMS	RHITND PIMS--response to OMB (7-20-12).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 41

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
Annual Number of Responses for this IC	41	41
Annual IC Time Burden (Hours)	155	155
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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