Information Collection

Induction Interview - Community Health Center Providers

IC 235132 under ICR 202007-0920-001 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Induction Interview - Community Health Center Providers	Form and Instruction
Att C6-2019 Induction Sample Card CHC Provider.docx	Instruction
2018 CHC Provider Induction Sample Card Att C5-2018 Induction Sample Card CHC Prov.pdf	Form and Instruction
2019 CDC Provider Questions Att C4-2019 NAMCS-1 List of all Proposed Questions for CHC Provider.docx	Form and Instruction

IC Title:

Induction Interview - Community Health Center Providers

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	2018 CHC Provider Induction Sample Card	Att C5-2018 Induction Sample Card CHC Prov.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	none	2019 CDC Provider Questions	Att C4-2019 NAMCS-1 List of all Proposed Questions for CHC Provider.docx	Yes	Yes	Fillable Fileable
Instruction			Att C6-2019 Induction Sample Card CHC Provider.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20--0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37697

Number of Respondents: 348

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	348	348
Annual IC Time Burden (Hours)	174	174
Annual IC Cost Burden (Dollars)	15,267	15,267

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.