MMP Short Facility Survey

Medical Monitoring Project Facility Survey

Documents and Forms

Document Name Document Type
MMP Short Facility Survey Form and Instruction
Medical Monitoring Project Short Facility Survey (screen Att 7 MMP short facility survey screenshots.docx Form and Instruction
Medical Monitoring Project Short Facility Survey (screen Att 7 MMP short facility survey screenshots.docx Form and Instruction
MMP Short Facility Survey (Word version) Att 6 MMP short facility survey instrument final_edited.docx Form and Instruction
MMP Short Facility Survey (Word version) Att 6 MMP short facility survey instrument final_edited.docx Form and Instruction

Information Collection (IC) Details

IC Title:	MMP Short Facility Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

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	n/a	Medical Monitoring Project Short Facility Survey (screenshots)	Att 7 MMP short facility survey screenshots.docx		Yes	Yes	Fillable Fileable
Form and Instruction	n/a	MMP Short Facility Survey (Word version)	Att 6 MMP short facility survey instrument final_edited.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	659	659

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.