Information Collection

Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement

IC 239208 under ICR 201902-0920-022 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1050 Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement	Form and Instruction
0920-1050 Peer Reviewers Evaluation Form Att 1_Peer Reviewers' Evaluation Form final.docx	Form and Instruction
0920-1050 _Service Delivery_SEP Peer Review Evaluation final.docx Template Information	IC Document
Att 2_PIA Email.pdf PIA email	IC Document

IC Title:

Special Emphasis Panel (SEP) Peer Review Evaluation for Quality Improvement

Agency IC Tracking Number:

0920-1050-20FM

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 and Instruction	0920-1050	Peer Reviewers Evaluation Form	Att 1_Peer Reviewers' Evaluation Form final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	500	500
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template Information	0920-1050 _Service Delivery_SEP Peer Review Evaluation final.docx	01/09/2020
PIA email	Att 2_PIA Email.pdf	01/09/2020

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