OSV Acknowledgement Form

Optimizing Virtual Care Grant Program Performance Measures

Documents and Forms

Document Name Document Type
Form 3 OSV Acknowledgement Form Form and Instruction
3 OSV Acknowledgement Form Salesforce OSV Communications_KVORTEX_Deloitte.docx Form and Instruction
3 OSV Acknowledgement Form Salesforce OSV Communications_KVORTEX_Deloitte.docx Form and Instruction

Information Collection (IC) Details

IC Title:	OSV Acknowledgement Form	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	3	OSV Acknowledgement Form	Salesforce OSV Communications_KVORTEX_Deloitte.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 550	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	550	550
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	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.