Information Collection

Health Center Controlled Networks Work Plan

IC 223046 under ICR 201608-0915-003 · OMB 0915-0285.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0285 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 41 Health Center Controlled Networks Work Plan	Form
41 HCCN Work Plan (track changes) HCCN Work Plan (track changes).docx	Form
41 HCCN Work Plan 2016 Cohort.pdf HCCN Work Plan 2016 Cohort.pdf	Form

IC Title:

Health Center Controlled Networks Work Plan

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	41	HCCN Work Plan (track changes)	HCCN Work Plan (track changes).docx		Yes	Yes	Fillable Fileable
Form	41	HCCN Work Plan 2016 Cohort.pdf	HCCN Work Plan 2016 Cohort.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 93

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
Annual Number of Responses for this IC	93	93
Annual IC Time Burden (Hours)	465	465
Annual IC Cost Burden (Dollars)	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.