Rural Health Information Technology Network Development

Rural Health Community-Based Grant Programs Data Collection Tool

Documents and Forms

Document Name Document Type
Form 1 Rural Health Information Technology Network Development Form and Instruction
1 RHITND PIMS RHITND PIMS-final.docx Form and Instruction
Outreach authority (2005).pdf Authority IC Document
RHITND_Demographics.pdf RHITND_Demographics IC Document
RHITND_Environment.pdf RHITND_Environment IC Document

Information Collection (IC) Details

IC Title:	Rural Health Information Technology Network Development	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	RHITND PIMS	RHITND PIMS-final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	41	0	41
Annual IC Time Burden (Hours)	233	78	155
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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