Information Collection

Assessment of the DAIDS Clinical Quality Assurance Program

IC 213234 under ICR 201212-0925-001 · OMB 0925-0668.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0668 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Assessment of the DAIDS Clinical Quality Assurance Program	Form and Instruction
1 Attachment 1 DAIDS cQMP Attachment 1 DAIDS cQMP Fillable PDF final w burden statement.pdf	Form and Instruction
DAIDS cQMP customer feedback.doc DAIDS cQMP customer feedback	IC Document

IC Title:

Assessment of the DAIDS Clinical Quality Assurance Program

Agency IC Tracking Number:

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	Attachment 1 DAIDS cQMP	Attachment 1 DAIDS cQMP Fillable PDF final w burden statement.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 160

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	320	320
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DAIDS cQMP customer feedback	DAIDS cQMP customer feedback.doc	09/24/2014

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