Information Collection

Delta States Rural Network Development Grant Program Performance Improvement Measurement System Measures

IC 211724 under ICR 202005-0915-004 · OMB 0915-0386.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0386 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Delta States Rural Network Development Grant Program Performance Improvement Measurement System Measures Form
1 Delta Draft PIMS FORM Delta Draft PIMS.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Delta States Rural Network Development Grant Program Performance Improvement Measurement System Measures	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	Delta Draft PIMS	FORM Delta Draft PIMS.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 12

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.