Information Collection

Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection

IC 243770 under ICR 202205-0906-002 · OMB 0906-0056.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection	Form and Instruction
FORM - HRSA FORHP COVID-19 Data Report 9.2021 TRACK.docx	Other-Tracked Changes
FORM - HRSA FORHP COVID-19 Data Report 9.2021 TRACK.docx	Other-Tracked Changes
1 HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx FORM - HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx	Form and Instruction
1 HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx FORM - HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx	FORM - HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx		Yes	Yes	Fillable Fileable
Other-Tracked Changes			FORM - HRSA FORHP COVID-19 Data Report 9.2021 TRACK.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,301

Number of Respondents for Small Entity: 2,301

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	43,719	43,719
Annual IC Time Burden (Hours)	14,427	14,427
Annual IC Cost Burden (Dollars)	0	0

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.