View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	BHPr Performance Measures Forms	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 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	-1,969	0	0	3,526
Annual IC Time Burden (Hours)	5,992	0	-1,745	0	0	7,737
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.