Information Collection

The Sickle Cell Disease Treatment Demonstration Regional Collaborative Program Quality Improvement Data Collection Form

IC 242427 under ICR 202006-0906-001 · OMB 0906-0055.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 The Sickle Cell Disease Treatment Demonstration Regional Collaborative Program Quality Improvement Data Collection Form	Form and Instruction
1 Quality Improvement Measures Data Collection Form APPENDIX B FORM SCDTDRCP Quality Improvement Measures Data Collection Documents.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Quality Improvement Measures Data Collection Form	APPENDIX B FORM SCDTDRCP Quality Improvement Measures Data Collection Documents.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	220	220
Annual IC Time Burden (Hours)	2,860	2,860
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.