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Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal
Small Rural Hospital Improvement Program (SHIP) COVID-19 Testing and Mitigation Reporting Portal
OMB: 0906-0066
IC ID: 249666
OMB.report
HHS/HRSA
OMB 0906-0066
ICR 202205-0906-001
IC 249666
( )
Documents and Forms
Document Name
Document Type
Form 0906-0066
Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal
Form and Instruction
0906-0066 HRSA FORHP COVID-19 Data Report
6. FORM - HRSA FORHP COVID-19 Data Report.docx
Form and Instruction
0906-0066 HRSA FORHP COVID-19 Data Report
6. FORM - HRSA FORHP COVID-19 Data Report.docx
Form and Instruction
5. Supporting Statement A - SHIP COVID Testing Mitigation Program 03.02.2022.docx
Supporting Statement A - SHIP COVID Testing Mitigation Program
IC Document
5. Supporting Statement A - SHIP COVID Testing Mitigation Program 03.02.2022.docx
Supporting Statement A - SHIP COVID Testing Mitigation Program
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal
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
0906-0066
HRSA FORHP COVID-19 Data Report
6. FORM - HRSA FORHP COVID-19 Data Report.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,540
Number of Respondents for Small Entity:
1,540
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
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
9,240
0
0
0
9,240
0
Annual IC Time Burden (Hours)
2,310
0
0
0
2,310
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A - SHIP COVID Testing Mitigation Program
5. Supporting Statement A - SHIP COVID Testing Mitigation Program 03.02.2022.docx
05/03/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.