Information Collection

Rural Health Care Services Outreach Supplement Performance Measures

IC 211611 under ICR 201405-0915-001 · OMB 0915-0385.

Documents and Forms

Document Name Document Type
Form 1 Rural Health Care Services Outreach Supplement Performance Measures Form
1 Rural Health Care Services Outreach Supplement Performan Outreach.Data Collection.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Health Care Services Outreach Supplement Performance Measures	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Rural Health Care Services Outreach Supplement Performance Measures	Outreach.Data Collection.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 52

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	78	78
Annual IC Cost Burden (Dollars)	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.