OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Black Lung Clinics Program Measures

IC 6545 under ICR 202506-0915-001 · OMB 0915-0292.

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

View Information Collection (IC)

Black Lung Clinics Program Measures
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 BLCP Measure Instrument BLCP Measure Instrument 10152024_Clean version 11.21.24.docx Yes Yes Fillable Fileable
Form and Instruction 1_Redline (11.24) BLCP Measure Instrument_Redline BLCP Measure Instrument 10152024_OMB Comment Updates_11.18.24.docx Yes Yes Fillable Fileable
Form and Instruction 1_Redline (06.25) FORHP 0915-0292 Black Lung Clinics Program Measures (proposed revisions June 5 2025) FORHP 0906-0010 Rural Health Network Development Measures (proposed revisions June 5 2025).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

15 15
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 15 0 0 0 0 15
Annual IC Time Burden (Hours) 105 0 0 0 0 105
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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