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

Sickle Cell Disease Treatment Demonstration Regional Collaborative Program: Quality Improvement and Performance Measure Data Collection

Documents and Forms

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

Information Collection (IC) Details

IC Title:	The Sickle Cell Disease Treatment Demonstration Regional Collaborative Program Quality Improvement Data Collection Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.