Information Collection

Medical Monitoring Project (MMP) Facility Survey

IC 245510 under ICR 202012-0920-020 · OMB 0920-1340.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Medical Monitoring Project (MMP) Facility Survey	Form and Instruction
Medical Monitoring Project Facility Survey (screenshots) Att 3 MMP facility survey screenshots.docx	Form and Instruction
Medical Monitoring Project Facility Survey (screenshots) Att 3 MMP facility survey screenshots.docx	Form and Instruction
Medical Monitoring Project Facility Survey (paper) Att 4 MMP facility survey instrument final_revised 11.20.2020.docx	Form and Instruction
Medical Monitoring Project Facility Survey (paper) Att 4 MMP facility survey instrument final_revised 11.20.2020.docx	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	n/a	Medical Monitoring Project Facility Survey (screenshots)	Att 3 MMP facility survey screenshots.docx		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Medical Monitoring Project Facility Survey (paper)	Att 4 MMP facility survey instrument final_revised 11.20.2020.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 85 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	21,120	21,120

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.