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Rural Outreach Benefits Counseling Program Measures
Rural Outreach Benefits Counseling Program Measures
OMB: 0906-0015
IC ID: 217946
OMB.report
HHS/HRSA
OMB 0906-0015
ICR 201508-0906-001
IC 217946
( )
Documents and Forms
Document Name
Document Type
Form 1
Rural Outreach Benefits Counseling Program Measures
Form
1 Rural Outreach Counseling Performance Measures Form
Rural Outreach Benefits Counseling Program Measures Form.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Rural Outreach Benefits Counseling Program Measures
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
1
Rural Outreach Counseling Performance Measures Form
Rural Outreach Benefits Counseling Program Measures Form.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10
0
10
0
0
0
Annual IC Time Burden (Hours)
20
0
20
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.
