Information Collection

Rural Health Care Services Outreach Program Measures

IC 215503 under ICR 201810-0906-001 · OMB 0906-0009.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0009 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Rural Health Care Services Outreach Program Measures Form
1 Outreach Final PIMS Measures Outreach Final PIMS Measures.pdf Form
0906-0009 Outreach OMB Number and Expiration.jpg 0906-0009 Outreach OMB Number and Expiration.jpg IC Document
0906-0009 Outreach Burden Statement.jpg 0906-0009 Outreach Burden Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Health Care Services Outreach Program Measures	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	Outreach Final PIMS Measures	Outreach Final PIMS Measures.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 25

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	88	88
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
0906-0009 Outreach OMB Number and Expiration.jpg	0906-0009 Outreach OMB Number and Expiration.jpg	10/24/2018
0906-0009 Outreach Burden Statement	0906-0009 Outreach Burden Statement.jpg	10/24/2018

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