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Federal forms, ICRs, and supporting documents

Information Collection

Attachment J – Data collection instrument: Site Visit Assessment

IC 227747 under ICR 202009-0935-001 · OMB 0935-0239.

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

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Attachment J – Data collection instrument: Site Visit Assessment
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 5 Site visits Attachment J_Site visit Assessment_Data clean.docx No   Fillable Fileable

Health Health Care Services

 

18 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 18 0 -22 0 0 40
Annual IC Time Burden (Hours) 72 0 -248 0 0 320
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment I – Site visit assessment_Cover letter and reminder notice.docx Attachment I_Site visit assessment_Cover letter and reminder notice_20170727.docx 07/28/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.