Information Collection

Exhibit C (Resident FTE Assessment)

IC 211278 under ICR 202210-0915-007 · OMB 0915-0247.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0247 can be found here:

Documents and Forms

Document Name Document Type
Form C Exhibit C (Resident FTE Assessment) Form
C Exhibit C (FTE Resident Assessment) Exhibit C (FTE Resident Assessment).docx Form
C Exhibit C (FTE Resident Assessment) Exhibit C (FTE Resident Assessment).docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Exhibit C (Resident FTE Assessment)	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	C	Exhibit C (FTE Resident Assessment)	Exhibit C (FTE Resident Assessment).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	120	60	60
Annual IC Time Burden (Hours)	440	230	210
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.