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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2. The Sickle Cell Disease Treatment Demonstration Regional Collaborative Program Performance Measures 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	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 %

	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

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.