View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Medicare Rural Hospital Flexibility Grant Program Performance Measures
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 1 Medicare Rural Hospital Flexibility Grant Program Measures OMB 0915-0363 – Revision.xlsx Yes Yes Fillable Fileable Signable

Health Public Health Monitoring

 

45 0
   
State, Local, and Tribal Governments
 
   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 45 0 0 0 0 45
Annual IC Time Burden (Hours) 3,150 0 -6,570 0 0 9,720
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
public comments Attachment A_NOSORH flex measures comment 2-28-13.pdf 04/25/2013
Instructions Attachment B_HRSA-5-H54-13-001 Flex NCC Progress Reportfinal with measures 02272013.docx 04/25/2013
spreadsheet version of the measures Attachment C_PIMSOMBmeasures.xlsx 04/25/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.