Information Collection

Voluntary Partnership Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

IC 6441 under ICR 200002-0915-004 · OMB 0915-0212.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Voluntary Partnership Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52,050	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	52,050	52,050
Annual IC Time Burden (Hours)	5,075	5,075
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.