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Program Eligibility Protocol
Assessing Strategies To Promote Children’s Engagement and Active Participation in Virtual Visits
OMB: 0906-0092
IC ID: 267283
OMB.report
HHS/HRSA
OMB 0906-0092
ICR 202407-0906-006
IC 267283
( )
Documents and Forms
Document Name
Document Type
Form 1
Program Eligibility Protocol
Form and Instruction
1 Program Eligibility Protocol
Appendix E_Active Engagement_Instrument1.docx
Form and Instruction
1 Program Eligibility Protocol (Track Changes 07302024)
0906-0092 1_Program Eligiblity Protocol.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Program Eligibility Protocol
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
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
Program Eligibility Protocol
Appendix E_Active Engagement_Instrument1.docx
Yes
Yes
Fillable Fileable
Form and Instruction
1
Program Eligibility Protocol (Track Changes 07302024)
0906-0092 1_Program Eligiblity Protocol.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:
16
Number of Respondents for Small Entity:
16
Affected Public:
State, Local, and Tribal Governments
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
16
0
0
0
0
16
Annual IC Time Burden (Hours)
16
0
0
0
0
16
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.