Information Collection

Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form

IC 211181 under ICR 202604-0915-002 · OMB 0915-0384.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Rural Health Network Development Planning Program Performance Measures Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form	Form and Instruction
1 Rural Health Network Development Planning Program Perfor Proposed Measures - 0915-0384 - FORHP - Network Planning - Revision - 03092026.docx	Form and Instruction
FINAL - Revised Supporting Statement A Document Network Planning 03082023.docx Supporting Statement	IC Document

IC Title:

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:

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 25

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	25	2	23
Annual IC Time Burden (Hours)	281	258	23
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement		03/08/2023

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

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