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Chicago-Participants, Implementation Staff, Local Hub Members
Patient Centered Care Collaboration to Improve Minority Health Project
OMB: 0990-0402
IC ID: 203038
OMB.report
HHS/HHSDM
OMB 0990-0402
ICR 201207-0990-005
IC 203038
( )
Documents and Forms
Document Name
Document Type
Attachment_3B-0990-PatientCentered.docx
Other-questionnaire
Attachment_3C-0990-PatientCentered.docx
Other-questions
Attachment_3D-0990-PatientCentered.docx
Other-questions
Attachment_3F-0990-PatientCentered.docx
Other-survey
Attachment_3G-0990-PatientCentered.docx
Other-questions
Attachment_3A patient centered care OMB commentsREVClean.docx
Other-Survey
Attachment_3E OMB commentsREVclean.docx
Other-Questions
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Chicago-Participants, Implementation Staff, Local Hub Members
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
Other-questionnaire
Attachment_3B-0990-PatientCentered.docx
Yes
No
Printable Only
Other-questions
Attachment_3C-0990-PatientCentered.docx
No
No
Printable Only
Other-questions
Attachment_3D-0990-PatientCentered.docx
No
No
Printable Only
Other-survey
Attachment_3F-0990-PatientCentered.docx
No
No
Printable Only
Other-questions
Attachment_3G-0990-PatientCentered.docx
No
No
Printable Only
Other-Survey
Attachment_3A patient centered care OMB commentsREVClean.docx
No
Printable Only
Other-Questions
Attachment_3E OMB commentsREVclean.docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
459
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
459
0
459
0
0
0
Annual IC Time Burden (Hours)
247
0
247
0
0
0
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.