Information Collection

Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form

IC 211181 under ICR 202303-0915-001 · OMB 0915-0384.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0384 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form	Form and Instruction
1 Network Planning PIMS Document Network Planning PIMS Document.docx	Form and Instruction
1 Network Planning PIMS Document Network Planning PIMS Document.docx	Form and Instruction
FINAL - Revised Supporting Statement A Document Network Planning 03082023.docx Supporting Statement	IC Document
FINAL - Revised Supporting Statement A Document Network Planning 03082023.docx Supporting Statement	IC Document

IC Title:

Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Network Planning PIMS Document	Network Planning PIMS Document.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23

Number of Respondents for Small Entity: 23

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	Previously Approved
Annual Number of Responses for this IC	23	-8	31
Annual IC Time Burden (Hours)	23	-8	31
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	FINAL - Revised Supporting Statement A Document Network Planning 03082023.docx	03/08/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.