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

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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.