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Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection
Rural Health Clinic COVID-19 (RHC COVID-19)Testing Program Data Collection
OMB: 0906-0056
IC ID: 243770
OMB.report
HHS/HRSA
OMB 0906-0056
ICR 202205-0906-002
IC 243770
( )
Documents and Forms
Document Name
Document Type
Form 1
Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection
Form and Instruction
FORM - HRSA FORHP COVID-19 Data Report 9.2021 TRACK.docx
Other-Tracked Changes
FORM - HRSA FORHP COVID-19 Data Report 9.2021 TRACK.docx
Other-Tracked Changes
1 HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx
FORM - HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx
Form and Instruction
1 HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx
FORM - HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection
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
1
HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx
FORM - HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx
Yes
Yes
Fillable Fileable
Other-Tracked Changes
FORM - HRSA FORHP COVID-19 Data Report 9.2021 TRACK.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:
2,301
Number of Respondents for Small Entity:
2,301
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
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
43,719
0
0
0
43,719
0
Annual IC Time Burden (Hours)
14,427
0
0
0
14,427
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.