Information Collection

NHHCIA NCC Income Analysis/ Plan Progress Report/ Work Plan Update

IC 258270 under ICR 202301-0915-005 · OMB 0915-0285.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0285 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6a NHHCIA NCC Income Analysis/ Plan Progress Report/ Work Plan Update	Form and Instruction
6a NHHCIA NCC Income Analysis Form NHHCIA NCC Income Analysis Form.docx	Form and Instruction
6a NHHCIA NCC Income Analysis Form NHHCIA NCC Income Analysis Form.docx	Form and Instruction
6b NHHCIA NCC Project Work Plan Progress Report NHHCIA NCC Project Work Plan Progress Report.docx	Form and Instruction
6b NHHCIA NCC Project Work Plan Progress Report NHHCIA NCC Project Work Plan Progress Report.docx	Form and Instruction
6c NHHCIA NCC Project Work Plan Update NHHCIA NCC Project Work Plan Update .docx	Form and Instruction
6c NHHCIA NCC Project Work Plan Update NHHCIA NCC Project Work Plan Update .docx	Form and Instruction

IC Title:

NHHCIA NCC Income Analysis/ Plan Progress Report/ Work Plan Update

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6a	NHHCIA NCC Income Analysis Form	NHHCIA NCC Income Analysis Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	6b	NHHCIA NCC Project Work Plan Progress Report	NHHCIA NCC Project Work Plan Progress Report.docx	Yes	Yes	Fillable Fileable
Form and Instruction	6c	NHHCIA NCC Project Work Plan Update	NHHCIA NCC Project Work Plan Update .docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18	18
Annual IC Time Burden (Hours)	3	3
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.