Information Collection

Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form

IC 211181 under ICR 202004-0915-008 · OMB 0915-0384.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0384 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form Form
1 FY2020 EHE Network Planning Perfomance Improvement Measu FY2020 EHE Network Planning Perfomance Improvement Measurement System (PIMS) - FORHP Final.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	FY2020 EHE Network Planning Perfomance Improvement Measurement System (PIMS) - FORHP Final.docx	FY2020 EHE Network Planning Perfomance Improvement Measurement System (PIMS) - FORHP 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: 31	Number of Respondents for Small Entity: 21

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	31	10	21
Annual IC Time Burden (Hours)	31	10	21
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.