Information Collection

Health Center Controlled Networks Progress Reports

IC 205055 under ICR 201603-0915-005 · OMB 0915-0360.

Documents and Forms

Document Name Document Type
Form 1 Health Center Controlled Networks Progress Reports Form and Instruction
1 Work Plan FINALWork Plan Template 03.21.16.xls Form and Instruction
2 Annual Progress Report Annual Progress Report Template Final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Center Controlled Networks Progress Reports	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 and Instruction	1	Work Plan	FINALWork Plan Template 03.21.16.xls		Yes	Yes	Fillable Fileable
Form and Instruction	2	Annual Progress Report	Annual Progress Report Template Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 86	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	86	26	60
Annual IC Time Burden (Hours)	2,382	720	1,662
Annual IC Cost Burden (Dollars)	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.