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BHPr Performance Measures Forms
BHPr Performance Report for Grants and Cooperative Agreements
OMB: 0915-0061
IC ID: 206385
OMB.report
HHS/HSA
OMB 0915-0061
ICR 201804-0915-001
IC 206385
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0061 can be found here:
2024-01-09 - Revision of a currently approved collection
2021-12-07 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form B
BHPr Performance Measures Forms
Form and Instruction
CaPrimary Care Offices Measures.docx
Other-Ca Doc Support
CbPerformance Measures.pdf
Other-Cb Supporting Docs
CcDNPH Mapping 2015.pdf
Other-Cc Supporting Doc
CdDMD Mapping 2015.pdf
Other-Cd supporting Doc
CeDHCFS Mapping 2015.pdf
Other-Ce Supporting Doc
Performance Measures.pdf
Other-Cf Supporting Doc
B Progress Report
AttachBProgressReport.docx
Form and Instruction
C PRGCA
AttachCPRGCA.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
BHPr Performance Measures Forms
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
B
Progress Report
AttachBProgressReport.docx
Yes
Yes
Fillable Fileable
Form and Instruction
C
PRGCA
AttachCPRGCA.docx
Yes
Yes
Fillable Fileable
Other-Ca Doc Support
CaPrimary Care Offices Measures.docx
Yes
No
Printable Only
Other-Cb Supporting Docs
CbPerformance Measures.pdf
Yes
No
Printable Only
Other-Cc Supporting Doc
CcDNPH Mapping 2015.pdf
Yes
No
Printable Only
Other-Cd supporting Doc
CdDMD Mapping 2015.pdf
Yes
No
Printable Only
Other-Ce Supporting Doc
CeDHCFS Mapping 2015.pdf
Yes
No
Printable Only
Other-Cf Supporting Doc
Performance Measures.pdf
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,557
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
1,557
0
0
0
0
1,557
Annual IC Time Burden (Hours)
5,992
0
0
0
0
5,992
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.