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Rural Health Care Services Outreach Supplement Performance Measures
Rural Health Care Services Outreach Supplement Performance Measures
OMB: 0915-0385
IC ID: 211611
OMB.report
HHS/HSA
OMB 0915-0385
ICR 201405-0915-001
IC 211611
( )
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
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
52
0
52
0
0
0
Annual IC Time Burden (Hours)
78
0
78
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
