Information Collection

Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal

IC 249666 under ICR 202110-0906-004 · OMB 0906-0066.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0066 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal Form and Instruction
1 HRSA FORHP COVID-19 Data Report .docx FORM - HRSA FORHP COVID-19 Data Report .docx Form and Instruction
1 HRSA FORHP COVID-19 Data Report .docx FORM - HRSA FORHP COVID-19 Data Report .docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	HRSA FORHP COVID-19 Data Report .docx	FORM - HRSA FORHP COVID-19 Data Report .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,540	Number of Respondents for Small Entity: 1,540

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	9,240	9,240
Annual IC Time Burden (Hours)	2,310	2,310
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.