Information Collection

Barriers to Care Assessment for WTC Health Program Care at MSSM

IC 232864 under ICR 201802-0920-007 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Barriers to Care Assessment for WTC Health Program Care at MSSM	Form
Barriers to Care Assessment Attachment A- Mount Sinai 2018.docx	Form
Mt. Sinai 2018- submission template_08302018.docx Request for Approval	IC Document

IC Title:

Barriers to Care Assessment for WTC Health Program Care at MSSM

Agency IC Tracking Number:

0920-0953-18AXX

IC Status: New

Obligation to Respond: Voluntary

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	none	Barriers to Care Assessment	Attachment A- Mount Sinai 2018.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,100	3,100
Annual IC Time Burden (Hours)	258	258
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Mt. Sinai 2018- submission template_08302018.docx	08/30/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.