Information Collection

BHPr Performance Measures Forms

IC 206385 under ICR 201603-0915-007 · OMB 0915-0061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0061 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form B Progress Report BHPr Performance Measures Forms	Form and Instruction
Form C PRGCA BHPr Performance Measures Forms	Form and Instruction
CaPrimary Care Offices Measures.docx	Other-Ca Doc Support
CbPerformance Measures.pdf	Other-Cb Supporting Docs
CcDNPH Mapping 2015.pdf	Other-Cc Supporting Doc
CdDMD Mapping 2015.pdf	Other-Cd supporting Doc
CeDHCFS Mapping 2015.pdf	Other-Ce Supporting Doc
Performance Measures.pdf	Other-Cf Supporting Doc
B Progress Report AttachBProgressReport.docx	Form and Instruction
C PRGCA AttachCPRGCA.docx	Form and Instruction

IC Title:

BHPr Performance Measures Forms

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:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	B	Yes	Yes	Fillable Fileable
Form and Instruction	C	Yes	Yes	Fillable Fileable
Other-Ca Doc Support		Yes	No	Printable Only
Other-Cb Supporting Docs		Yes	No	Printable Only
Other-Cc Supporting Doc		Yes	No	Printable Only
Other-Cd supporting Doc		Yes	No	Printable Only
Other-Ce Supporting Doc		Yes	No	Printable Only
Other-Cf Supporting Doc		Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,557

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,557	-1,969	3,526
Annual IC Time Burden (Hours)	5,992	-1,745	7,737
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].