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Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Database
Data Collection Tool for Rural Health Community-Based Grant Programs
OMB: 0915-0319
IC ID: 184012
OMB.report
HHS/HSA
OMB 0915-0319
ICR 201406-0915-001
IC 184012
( )
Documents and Forms
Document Name
Document Type
Form 4
Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Database
Form
4 Small Health Care Provider Quality Improvement Program P
4 Quality Program PIMS Measures.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Database
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
4
Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System Database
4 Quality Program PIMS Measures.docx
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:
30
Number of Respondents for Small Entity:
30
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
30
0
-29
0
0
59
Annual IC Time Burden (Hours)
218
0
-254
0
0
472
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.