Information Collection

2022 PMHCA Practice- Level Survey

IC 258759 under ICR 202302-0906-003 · OMB 0906-0074.

Documents and Forms

Document Name Document Type
Form 2A 2022 PMHCA Practice- Level Survey Form and Instruction
Form 2A 2022 PMHCA Practice- Level Survey Form and Instruction
2A 2022 PHMCA Practice-Level Survey Attachment B2 - Practice-Level Survey2 - Copy.docx Form and Instruction
2A 2022 PHMCA Practice-Level Survey Attachment B2 - Practice-Level Survey2 - Copy.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2022 PMHCA Practice- Level Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	2A	2022 PHMCA Practice-Level Survey	Attachment B2 - Practice-Level Survey2 - Copy.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 615	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
Annual Number of Responses for this IC	1,845	1,845
Annual IC Time Burden (Hours)	461	461
Annual IC Cost Burden (Dollars)	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.