Small Health Care Provider Quality Improvement Grant Program

Rural Health Community-Based Grant Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0319 can be found here:

Documents and Forms

Document Name Document Type
Form rh4 Small Health Care Provider Quality Improvement Grant Program Form and Instruction
orhp table descriptions.doc Instruction
rh4 rh4 orhp shc.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Small Health Care Provider Quality Improvement Grant Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	rh4	rh4	orhp shc.doc		Yes	Yes	Fillable Fileable
Instruction			orhp table descriptions.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	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.