Health Center Organizational Assessment

Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

OMB: 0920-1156

IC ID: 222374

Information Collection (IC) Details

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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

 

4 0
   
State, Local, and Tribal Governments
 
   0 %

  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 4 0 0 0 0 4
Annual IC Time Burden (Hours) 8 0 0 0 0 8
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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