OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Center Organizational Assessment

IC 222364 under ICR 201912-0920-012 · OMB 0920-1156.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Health Center Organizational Assessment
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1156 Health Center Org Assessment Att 3a Health Center Organizational Assessment 6_22_2016 final.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1156 Health Center Org Assessment Online Att 3b Health Center Organizational Assessment Online Version.docx Yes Yes Fillable Fileable

Health Health Care Services

 

21 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   90 %

  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 21 0 0 0 0 21
Annual IC Time Burden (Hours) 42 0 0 0 0 42
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.