Rural Health Care Services Outreach Program Measures

Rural Health Care Services Outreach Performance Improvement and Measurement Systems (PIMS) Measures

Documents and Forms

Document Name Document Type
Form 1 Rural Health Care Services Outreach Program Measures Form
1 Rural Health Care Services Outreach Program.docx FORM - Rural Health Care Services Outreach Program.docx Form
1 Rural Health Care Services Outreach Program.docx FORM - Rural Health Care Services Outreach Program.docx Form

Information Collection (IC) Details

IC Title:	Rural Health Care Services Outreach Program Measures	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.docx	FORM - Rural Health Care Services Outreach Program.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61	Number of Respondents for Small Entity: 61

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, 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	61	36	25
Annual IC Time Burden (Hours)	458	370	88
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.