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Federal forms, ICRs, and supporting documents

Information Collection

Health Center Component Facility Interview (Survey year: 2025 & 2027)

IC 247676 under ICR 202412-0920-002 · OMB 0920-0234.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Health Center Component Facility Interview (Survey year: 2025 & 2027) 0920-0234
 
Yes Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0234 2025-2027 Health Center Component Facility Interview Attachment C2_2025-2027 Health Center Facility Interview.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

221 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 221 0 148 0 0 73
Annual IC Time Burden (Hours) 166 0 111 0 0 55
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.