Rural Health Care Services Outreach Program Measures

Rural Health Care Services Outreach Performance Improvement and Measurement Systems (PIMS) Measures

Documents and Forms

Document Name Document Type
Form 1 Rural Health Care Services Outreach Program Measures Form
1 Rural Health Care Services Outreach Program.docx Outreach Program Measures.docx Form

Information Collection (IC) Details

IC Title:	Rural Health Care Services Outreach Program Measures	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Rural Health Care Services Outreach Program.docx	Outreach Program Measures.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61	Number of Respondents for Small Entity: 61

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	61	0	61
Annual IC Time Burden (Hours)	488	30	458
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.