Office of Healthcare Information and Counseling (OHIC) Profiles at ACL

Office of Healthcare Information and Counseling (OHIC) Profiles at ACL

OMB: 0985-0075

IC ID: 258450

Information Collection (IC) Details

View Information Collection (IC)

Office of Healthcare Information and Counseling (OHIC) Profiles at ACL
 
No New
 
Voluntary
 
45 CFR 1321

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA MIPPA Sub Recipients Report Template 0985New MIPPASubRecipientsReportTemplate Ins 1.pdf Yes Yes Fillable Fileable
Form and Instruction NA OHIC Profiles Template 0985New OHICProfilesDataCollectionInstrument Ins 2.pdf Yes Yes Fillable Fileable
Instruction 0985New OHICProfilesSupplementalInstructions Ins 3.pdf Yes Yes Fillable Fileable
Form and Instruction NA OHIC SMP Sub Recipient Report Template 0985New OHIC SMPSubRecipientsReportTemplate Ins 4.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

125 0
   
State, Local, and Tribal Governments
 
   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 125 0 125 0 0 0
Annual IC Time Burden (Hours) 104 0 104 0 0 0
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.

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