Survey to Evaluate the Use of HITRC Tool, Care Transition Summary Toolkit, by REC

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (HITRC)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0003 can be found here:

Documents and Forms

Document Name Document Type
Attachment A-Survey on the Care Transition Summary Toolkit.docx Other-survey

Information Collection (IC) Details

IC Title:	Survey to Evaluate the Use of HITRC Tool, Care Transition Summary Toolkit, by REC	Agency IC Tracking Number:

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-survey			Attachment A-Survey on the Care Transition Summary Toolkit.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,240	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

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	1,240	0	0	0	0	0
Annual IC Time Burden (Hours)	207	0	0	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.