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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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.