Information Collection

Rural Network Allied Health Training Program

IC 221714 under ICR 201605-0906-001 · OMB 0906-0021.

Documents and Forms

Document Name Document Type
Form 1 Rural Network Allied Health Training Program Form and Instruction
1 OMB Passback PIMS Measures-CLEAN 11-10-16.docx OMB Passback PIMS Measures-CLEAN 11-10-16.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Network Allied Health Training Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	OMB Passback PIMS Measures-CLEAN 11-10-16.docx	OMB Passback PIMS Measures-CLEAN 11-10-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 10

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	66	66
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.