HRSA Client-Level Data Reporting System: Service Provider Report

HRSA HAB Client-Level Data Reporting System

OMB: 0915-0323

IC ID: 187334

Information Collection (IC) Details

View Information Collection (IC)

HRSA Client-Level Data Reporting System: Service Provider Report
 
No Unchanged
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form C C - 2017_Service_Provider_Form_Screenshots.docx C - 2017_Service_Provider_Form_Screenshots.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,793 0
   
State, Local, and Tribal Governments
 
   100 %

  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 1,793 0 0 0 0 1,793
Annual IC Time Burden (Hours) 30,481 0 0 0 0 30,481
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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