Information Collection

Comment request letters on 1) Procedure SA 106, "The Management Review Board" and 2) Staff Evaluation of the Patient Release Program

IC 227733 under ICR 201510-3150-007 · OMB 3150-0029.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0029 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Comment request letter on procedure SA-106, THE MANAGEMENT REVIEW BOARD.docx	Other-Comment request letter
Generic submission template for SA 106.pdf Generic submission template for Comment Request on SA-106, The Management Review Board	IC Document
Generic submission template for comment request on patient release.pdf Generic submission template for comment request on staff evaluation of patient release program	IC Document
SA-106, The Management Review Board, with changes tracked.docx SA-106 "The Management Review Board" for comment, with changes tracked	IC Document

IC Title:

Comment request letters on 1) Procedure SA 106, "The Management Review Board" and 2) Staff Evaluation of the Patient Release Program

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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
Other-Comment request letter			Comment request letter on procedure SA-106, THE MANAGEMENT REVIEW BOARD.docx		Yes	Yes	Printable Only

Line of Business: Energy

Subfunction: Energy Supply

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 39

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	78	78
Annual IC Time Burden (Hours)	156	156
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic submission template for Comment Request on SA-106, The Management Review Board	Generic submission template for SA 106.pdf	07/27/2017
Generic submission template for comment request on staff evaluation of patient release program	Generic submission template for comment request on patient release.pdf	07/27/2017
SA-106 "The Management Review Board" for comment, with changes tracked	SA-106, The Management Review Board, with changes tracked.docx	07/27/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.