Information Collection

BHW Performance Measures Forms

IC 206385 under ICR 202112-0915-001 · OMB 0915-0061.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0061 can be found here:

Documents and Forms

Document Name Document Type
Form 1 BHW Performance Measures Forms Form and Instruction
1 Performance Metrics.pdf Appendix C - Performance Metrics.pdf Form and Instruction
1 Performance Metrics.pdf Appendix C - Performance Metrics.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	BHW Performance Measures Forms	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	Performance Metrics.pdf	Appendix C - Performance Metrics.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,630	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,630	130	1,500
Annual IC Time Burden (Hours)	5,402	-308	5,710
Annual IC Cost Burden (Dollars)	0	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.