Information Collection

Rural Health Care Services Outreach Program Performance Improvement and Measurement System Database

IC 184009 under ICR 201406-0915-001 · OMB 0915-0319.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Rural Health Care Services Outreach Program Performance Improvement and Measurement System Database	Form
1 Rural Health Care Services Outreach Program Performance 1 Outreach PIMS .docx	Form

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	1	Rural Health Care Services Outreach Program Performance Improvement and Measurement System Database	1 Outreach PIMS .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 71

Number of Respondents for Small Entity: 71

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	71	-40	111
Annual IC Time Burden (Hours)	142	-219	361
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.