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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Program Application	Form
Million Hearts® Hospital/Health System Recognition Progr 19TG Att 2a. Data Collection Tool Final.docx	Form

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.