State Offices of Rural Health TA Data Collection Form

State Office of Rural Health Grant Technical Assistance

OMB: 0915-0322

IC ID: 186810

Information Collection (IC) Details

View Information Collection (IC)

State Offices of Rural Health TA Data Collection Form
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 SORH PIMS Screenshot 2020 PB.jpg SORH PIMS Screenshot 2020 PB.jpg Yes Yes Fillable Fileable

Health Public Health Monitoring

 

50 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 50 0 0 0 0 50
Annual IC Time Burden (Hours) 675 0 50 0 0 625
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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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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