Clinical Performance Measures

The Health Center Program Application Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0285 can be found here:

Documents and Forms

Document Name Document Type
Form 7E Clinical Performance Measures Form and Instruction
7 Clinical Performance Measures Clean.docx Clinical Performance Measures Clean.docx Form and Instruction
7E Clinical Performance Measures edits.docx Clinical Performance Measures edits.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Clinical Performance Measures	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	7E	Clinical Performance Measures edits.docx	Clinical Performance Measures edits.docx		Yes	Yes	Fillable Fileable
Form and Instruction	7	Clinical Performance Measures Clean.docx	Clinical Performance Measures Clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,058	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,058	1,058
Annual IC Time Burden (Hours)	3,703	3,703
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.