Information Collection

Rural Health Information Technology Network Development

IC 202626 under ICR 201305-0915-005 · OMB 0915-0354.

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 RHITND PIMS RHITND PIMS-final.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:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	RHITND PIMS	RHITND PIMS-final.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	Previously Approved
Annual Number of Responses for this IC	41	0	41
Annual IC Time Burden (Hours)	233	78	155
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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