Information Collection

Delta States Rural Network Development Grant Program Performance Improvement Measurement System Measures - State Local Tribal

IC 260179 under ICR 202305-0915-003 · OMB 0915-0386.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0386 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Delta States Rural Network Development Grant Program Performance Improvement Measurement System Measures - State Local Tribal	Form and Instruction
1 Performance Improvement Measurement System (PIMS) FINAL Delta States PIMS_2020-2023 Instrument.docx	Form and Instruction
1 Performance Improvement Measurement System (PIMS) FINAL Delta States PIMS_2020-2023 Instrument.docx	Form and Instruction

IC Title:

Delta States Rural Network Development Grant Program Performance Improvement Measurement System Measures - State Local Tribal

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Performance Improvement Measurement System (PIMS)	FINAL Delta States PIMS_2020-2023 Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4

Number of Respondents for Small Entity: 4

Affected Public: State, Local, and Tribal Governments

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	4	4
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.