Information Collection

Program Application

IC 237207 under ICR 201908-0920-001 · OMB 0920-1274.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1274 can be found here:

Documents and Forms

Document Name Document Type
Program Application Form
Million Hearts® Hospital/Health System Recognition Progr 19TG Att 2a. Data Collection Tool Final.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Program Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Million HeartsÂ® Hospital/Health System Recognition Program Application	19TG Att 2a. Data Collection Tool Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	267	267
Annual IC Cost Burden (Dollars)	14,317	14,317

Documents for IC

Title	Document	Date Uploaded
No associated records found

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