Information Collection

Initial development of program evaluation (§ 491.11)

IC 270173 under ICR 202408-0938-016 · OMB 0938-0334.

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IC Title:	Initial development of program evaluation (§ 491.11)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 491.11

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,091	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,091	1,091
Annual IC Time Burden (Hours)	10,910	10,910
Annual IC Cost Burden (Dollars)	0	0

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