Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection

Rural Health Clinic COVID-19 (RHC COVID-19)Testing Program Data Collection

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0056 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection Form and Instruction
1 HRSA FORHP COVID-19 Data Report 12.18.2020.docx HRSA FORHP COVID-19 Data Report 12.18.2020.docx Form and Instruction
1 HRSA FORHP COVID-19 Data Report 12.18.2020.docx HRSA FORHP COVID-19 Data Report 12.18.2020.docx Form and Instruction

Information Collection (IC) Details

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: 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	1	HRSA FORHP COVID-19 Data Report 12.18.2020.docx	HRSA FORHP COVID-19 Data Report 12.18.2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,406	Number of Respondents for Small Entity: 2,358

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	28,872	28,872
Annual IC Time Burden (Hours)	7,218	7,218
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.