Nomination Form

Million Hearts Hypertension Control Challenge

OMB: 0920-0976

IC ID: 206920

Documents and Forms
Document Name
Document Type
Form
Other-WIORD
Form
Form
IC Document
IC Document
Information Collection (IC) Details

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Nomination Form 15QG
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Nomination Form Attachment 3a Nomination Form_7 23 2013.docm Yes Yes Fillable Fileable
Form none Website Screenshots Attachment 6 Screenshots 7-24-2013.pdf Yes Yes Fillable Fileable
Other-WIORD Att 3a (revised_3 04 2015) Nomination Form.docm Yes Yes Fillable Fileable

Health Immunization Management

 

1,735 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 1,735 0 0 0 0 1,735
Annual IC Time Burden (Hours) 868 0 0 0 0 868
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Confirmation Email Attachment 3b. Confirmation email_4 4 2013.docx 05/08/2013
Justification for Change 0920-0976 Change Request_3 05 2015.docx 03/05/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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