Community College HIT Consortium Application Form

Community College Consortia Program to Education Information Technology Professionals in Health Care

Documents and Forms

Document Name Document Type
Form 1 Community College HIT Consortium Application Form Form and Instruction
1 Community College HIT Consortium Application Form Community College HIT Consortium Application Form ver1.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Community College HIT Consortium Application Form	Agency IC Tracking Number:

Is this a Common Form?		IC Status: New

Obligation to Respond: Mandatory

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	1	Community College HIT Consortium Application Form	Community College HIT Consortium Application Form ver1.doc		Yes	Yes	Printable Only

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	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	25	25
Annual IC Time Burden (Hours)	22,750	22,750
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.