Information Collection

CHCs: Use of Azara/Population Health Tool

IC 266248 under ICR 202403-0990-008 · OMB 0990-0482.

Documents and Forms

Document Name Document Type
Form 1 CHCs: Use of Azara/Population Health Tool Form and Instruction
1 Azara/Population Health Tool Survey Azara Population Health Tool Survey.pdf Form and Instruction
1 Azara/Population Health Tool Survey Azara Population Health Tool Survey.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CHCs: Use of Azara/Population Health Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

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	Azara/Population Health Tool Survey	Azara Population Health Tool Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	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.