Health Center Organizational Assessment

Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

OMB: 0920-1156

IC ID: 222364

Information Collection (IC) Details

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Health Center Organizational Assessment
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction N/A Att 4 Health Center Organizational Assessment 03_01_2017 clean Att 4 Health Center Organizational Assessment 03_01_2017 clean.docx Yes Yes Fillable Printable
Form N/A Att 4a Health Center Organizational Assessment Online Version Att 4a Health Center Organizational Assessment Online Version.docx Yes Yes Fillable Fileable

Health Health Care Services

 

21 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21 0 0 0 0 21
Annual IC Time Burden (Hours) 42 0 0 0 0 42
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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