VOLUNTARY "PARTNER" SURVEYS TO IMPLEMENT EXECUTIVE ORDER 12862 IN THE PUBLIC HEALTH SERVICE

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Forms and supporting documents for this ICR

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Information collection document groups

IC ID	Collection	Type	Status	Form
112459	VOLUNTARY "PARTNER" SURVEYS TO IMPLEMENT EXECUTIVE ORDER 12862 IN THE PUBLIC HEALTH SERVICE		Migrated

ICR Details

OMB Control No: 0937-0203	ICR Reference No: 199404-0937-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/OASH	Agency Tracking No:
Title: VOLUNTARY "PARTNER" SURVEYS TO IMPLEMENT EXECUTIVE ORDER 12862 IN THE PUBLIC HEALTH SERVICE
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/20/1994
	Date Received in OIRA: 04/04/1994
Terms of Clearance: This PHS generic clearance request for "partners" and "regulated entities" (and the enclosed revisions to the Supporting Statement) are approved for use through 4/97 under the following conditions: 1) PHS provides OMB with copies of the proposed surveys ten days before dissemination; and 2) PHS incorporates the attached guidance "Consider ation for Information Collections of Customer Satisfaction by Regulato of Regulated Entities" in conducting surveys of "regulated entities" o "partners."

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/1997	04/30/1997
Responses	19,460	0	0
Time Burden (Hours)	7,795	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THESE VOLUNTARY CUSTOMER SURVEYS WILL IMPLEMENT E.O. 12862 WITHIN PHS AMONG OUR "PARTNERS" IN DELIVERY OF SERVICES TO THE PUBLIC. PARTNERS INCLUDE STATE OR LOCAL GOVERNMENTS, SERVICE PROVIDERS, RESEARCHERS, AN REGULATED ENTITIES. RESULTING INFORMATION WILL BE USED TO ASSESS STRENGTHS AND WEAKNESSES IN PROGRAM SERVICES AND TO PLAN AND REDIRECT RESOURCES AND EFFORTS TO IMPROVE OR MAINTAIN A HIGH QUALITY OF SERVICE

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
VOLUNTARY "PARTNER" SURVEYS TO IMPLEMENT EXECUTIVE ORDER 12862 IN THE PUBLIC HEALTH SERVICE

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	19,460	0	0	19,460	0	0
Annual Time Burden (Hours)	7,795	0	0	7,795	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/04/1994

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