DIR Grant Reviewer Recruitment Form

The Division of Independent Review Application Reviewer Recruitment Form

Documents and Forms

Document Name Document Type
Form 1 DIR Grant Reviewer Recruitment Form Form and Instruction
1 Updated Burden Statement Screenshot.pdf Updated Burden Statement Screenshot.pdf Form and Instruction
1 Updated Burden Statement Screenshot.pdf Updated Burden Statement Screenshot.pdf Form and Instruction
Reviewer notice letter.docx Reviewer notice letter IC Document

Information Collection (IC) Details

IC Title:	DIR Grant Reviewer Recruitment Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	Updated Burden Statement Screenshot.pdf	Updated Burden Statement Screenshot.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	9,700	553	9,147
Annual IC Time Burden (Hours)	1,727	-1,119	2,846
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.