Information Collection

Community of Practice Pre-Assessment Instrument

IC 260186 under ICR 202305-0915-004 · OMB 0915-0391.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0391 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Community of Practice Pre-Assessment Instrument	Form and Instruction
2 Community of Practice Pre-Assessment Form 2_COP Pre-Assessment Instrument.docx	Form and Instruction
2 Community of Practice Pre-Assessment Form 2_COP Pre-Assessment Instrument.docx	Form and Instruction

IC Title:

Community of Practice Pre-Assessment Instrument

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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	2	Community of Practice Pre-Assessment	Form 2_COP Pre-Assessment 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: 180

Number of Respondents for Small Entity: 180

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
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.