Information Collection

Health Center Controlled Networks Progress Reports

IC 205055 under ICR 201305-0915-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 2 Health Center Controlled Networks Progress Reports	Form and Instruction
2 Repport Table Instructions Report_Table_Instructions.docx	Form and Instruction
1 work plan APPENDIX B Instructions for Work Plan_EL 04302013v1.docx	Form and Instruction
Report Table 61.docx Report Table 61	IC Document
Report Table.txt Progress Report template	IC Document
Copy of hccnworkplan_EL 04302013v1_track changes.xls Copy of hccnworkplan_EL 04302013v1_track changes	IC Document

IC Title:

Health Center Controlled Networks Progress Reports

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	2	Repport Table Instructions	Report_Table_Instructions.docx		Yes	Yes	Fillable Fileable
Form and Instruction	1	work plan	APPENDIX B Instructions for Work Plan_EL 04302013v1.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	Previously Approved
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

table that charts IC Documents
Title	Document	Date Uploaded
Report Table 61	Report Table 61.docx	03/12/2013
Progress Report template	Report Table.txt	11/20/2012
Copy of hccnworkplan_EL 04302013v1_track changes	Copy of hccnworkplan_EL 04302013v1_track changes.xls	05/29/2013

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