OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Hospital Campaign Activity Scorecard

IC 209057 under ICR 202008-0915-005 · OMB 0915-0373.

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Hospital Campaign Activity Scorecard
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 R Scorecard - 2020 Hospital Campaign Scorecard Change Memo REDLINE.pdf 08.03.2020 Scorecard - 2020 Hospital Campaign Scorecard Change Memo REDLINE.pdf Yes Yes Fillable Fileable
Form 1 C Scorecard - 2020 Hospital Campaign Scorecard Change Memo CLEAN.pdf 08.03.2020 Scorecard - 2020 Hospital Campaign Scorecard Change Memo CLEAN.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,500 500
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,500 0 0 0 0 1,500
Annual IC Time Burden (Hours) 375 0 0 0 0 375
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0373 Hospital Campaign Change Memo CLEAN 0373 Hospital Campaign Change Memo CLEAN.docx 09/26/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.