Information Collection

Health Center Controlled Networks Progress Reports

IC 205055 under ICR 201212-0915-002 · OMB 0915-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0360 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Health Center Controlled Networks Progress Reports	Form and Instruction
1 Work Plan APPENDIX B Instructions for Work Plan.docx	Form and Instruction
2 Progress Report Report_Table_Instructions.docx	Form and Instruction
Report Table.txt Progress Report template	IC Document
Copy of hccnworkplan.xls Copy of hccnworkplan	IC Document
Report Table 61.docx Report Table 61	IC Document

IC Title:

Health Center Controlled Networks Progress Reports

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	Work Plan	APPENDIX B Instructions for Work Plan.docx		Yes	Yes	Fillable Fileable
Form and Instruction	2	Progress Report	Report_Table_Instructions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	60	60
Annual IC Time Burden (Hours)	1,662	1,662
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.