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Survey on Gender, Ethnic and Racial Backgrounds of Clients and Staff at Bureau of Primary Health Care Supported Community-Based Health Service Sites
Survey on Gender, Ethnic and Racial Backgrounds of Clients and Staff at Bureau of Primary Health Care Supported Community-Based Health Service Sites
OMB: 0915-0265
IC ID: 6515
OMB.report
HHS/HSA
OMB 0915-0265
ICR 200208-0915-002
IC 6515
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Survey on Gender, Ethnic and Racial Backgrounds of Clients and Staff at Bureau of Primary Health Care Supported Community-Based Health Service Sites
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
Form
HRSA-106
No
No
Form
HRSA-105
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
300
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
11,250
0
11,250
0
0
0
Annual IC Time Burden (Hours)
1,000
0
1,000
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.