OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Gap Analysis

IC 248491 under ICR 202209-0935-004 · OMB 0935-0260.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Gap Analysis
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3 Attachment B: ICU/Non-ICU Gap Analysis Att B ICU-Non-ICU Gap Analysis.docx Yes Yes Fillable Fileable
Form and Instruction 4 Attachment C: Surgical Services Gap Analysis Att C Surgical Services Gap Analysis.docx Yes Yes Fillable Fileable
Form and Instruction 5 Attachment D: LTC Gap Analysis Att D LTC Gap Analysis.docx Yes Yes Fillable Fileable

Health Health Care Services

 

467 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 934 0 0 0 0 934
Annual IC Time Burden (Hours) 934 0 0 0 0 934
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.