Information Collection

GenIC #82 (unchanged from MACPro): Quality Improvement Affinity Group Expression of Interest Form

IC 271243 under ICR 202409-0938-028 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form GenIC #82 GenIC #82 (unchanged from MACPro): Quality Improvement Affinity Group Expression of Interest Form	Form and Instruction
GenIC #82 Quality Improvement Affinity Group Expression of Interes GenIC 82 - 508UniversalEOI (2024 version 3).docx	Form and Instruction
GenIC #82 Quality Improvement Affinity Group Expression of Interes GenIC 82 - 508UniversalEOI (2024 version 3).docx	Form and Instruction

IC Title:

GenIC #82 (unchanged from MACPro): Quality Improvement Affinity Group Expression of Interest Form

Agency IC Tracking Number:

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	GenIC #82	Quality Improvement Affinity Group Expression of Interest Form	GenIC 82 - 508UniversalEOI (2024 version 3).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	60	60
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.