Information Collection

Attachment 6 Instructions and Review Panel Survey

IC 215699 under ICR 201503-0925-005 · OMB 0925-0727.

Documents and Forms

Document Name Document Type
Form 4 Attachment 6 Instructions and Review Panel Survey Form and Instruction
4 Instructions and Review Panel Scoring Sheet Attach6_ReviewPanelScore_PS-OC_6-17-2015.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment 6 Instructions and Review Panel Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Instructions and Review Panel Scoring Sheet	Attach6_ReviewPanelScore_PS-OC_6-17-2015.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	600	600
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.