Information Collection

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

IC 6443 under ICR 200709-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form donor satisfaction Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration	Form and Instruction
donor satisfaction donor satisfaction survey Donor Satisfaction Survey.doc	Form and Instruction
Donor Advocacy letter.doc donor letter	IC Document
customer exec order.pdf executive order	IC Document
customer 1998 memo.doc White House memo	IC Document

IC Title:

Voluntary Partner 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: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	donor satisfaction survey	donor satisfaction survey	Donor Satisfaction Survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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 %

table that charts list of burden
	Requested	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

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