Information Collection

PT, Site Characteristics and Outcomes

IC 272956 under ICR 202412-0906-005 · OMB unassigned.

Documents and Forms

Document Name Document Type
Form 3 PT, Site Characteristics and Outcomes Form and Instruction
3 PT, Site Characteristics and Outcomes PT-SC_30 day_final.pdf Form and Instruction
3 PT-SC_finaldraftOMB 05.29.2025 PT-SC_finaldraftOMB 05.29.2025.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	PT, Site Characteristics and Outcomes	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	3	PT-SC_finaldraftOMB 05.29.2025	PT-SC_finaldraftOMB 05.29.2025.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 128	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 80 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	128	128
Annual IC Time Burden (Hours)	40	40
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.