Information Collection

Rural Health Care Coordination Program Performance Improvement Measurement System;

IC 222525 under ICR 202105-0906-002 · OMB 0906-0024.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0024 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Rural Health Care Coordination Program Performance Improvement Measurement System; Form and Instruction
1 Rural Health Care Coordination Program Performance Measu FORM Rural Health Care Coordination Program Performance Measures 5.18. docx.docx Form and Instruction
1 Rural Health Care Coordination Program Performance Measu FORM Rural Health Care Coordination Program Performance Measures 5.18. docx.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Health Care Coordination Program Performance Improvement Measurement System;	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	Rural Health Care Coordination Program Performance Measures	FORM Rural Health Care Coordination Program Performance Measures 5.18. docx.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 10

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	10	10
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.