Rural Health Care Services Outreach Program Performance Improvement and Measurement System Database

Data Collection Tool for Rural Health Community-Based Grant Programs

Documents and Forms

Document Name Document Type
Form 1 Rural Health Care Services Outreach Program Performance Improvement and Measurement System Database Form
1 Rural Health Care Services Outreach Program Performance 1 Outreach PIMS .docx Form

Information Collection (IC) Details

IC Title:	Rural Health Care Services Outreach Program Performance Improvement and Measurement System Database	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	1	Rural Health Care Services Outreach Program Performance Improvement and Measurement System Database	1 Outreach PIMS .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 71	Number of Respondents for Small Entity: 71

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	71	-40	111
Annual IC Time Burden (Hours)	142	-219	361
Annual IC Cost Burden (Dollars)	0	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.