Information Collection

2. The Sickle Cell Disease Treatment Demonstration Regional Collaborative Program Performance Measures Data Collection Form

IC 242428 under ICR 202006-0906-001 · OMB 0906-0055.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 2. The Sickle Cell Disease Treatment Demonstration Regional Collaborative Program Performance Measures Data Collection Form	Form and Instruction
2 Performance Measures Data Collection Documents.pdf APPENDIX C FORM SCDTDRCP Performance 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	2	Performance Measures Data Collection Documents.pdf	APPENDIX C FORM SCDTDRCP Performance 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: 305

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	305	305
Annual IC Time Burden (Hours)	305	305
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.