BHPr Funding Strategy Evaluation

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⚠️ Notice: This information collection may be referencing outdated material.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 PCRE-1 BHPr Funding Strategy Evaluation Form
PCRE-1 PCRE Eligible Funded Script - Eligible Applicants Applied Funded-12 13 10 Final.docx Form
PCRE-2 PCRE-Eligible Inquiry Did Not Apply Script - Eligible Applicants Inquiry Did Not Apply-12 13 10 Final.doc Form
PCRE-3 PCRE-Eligible No Inquiry Did Not Apply Script - Eligible Organizations no inquiry did not apply-12 13 10 Final.doc Form
BHPR-PCRE Funding Strategy Eval Project-FINAL Supporting Statement-12.14.10.rtf BHPR Funding Strategy Evaluation Supporting Statement IC Document
Evaluation Interview One-pager.docx BHPR Funding Strategy Informational One-Pager IC Document

Information Collection (IC) Details

IC Title:	BHPr Funding Strategy Evaluation	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PCRE-1	PCRE Eligible Funded	Script - Eligible Applicants Applied Funded-12 13 10 Final.docx	No	No	Printable Only
Form	PCRE-2	PCRE-Eligible Inquiry Did Not Apply	Script - Eligible Applicants Inquiry Did Not Apply-12 13 10 Final.doc	No	No	Printable Only
Form	PCRE-3	PCRE-Eligible No Inquiry Did Not Apply	Script - Eligible Organizations no inquiry did not apply-12 13 10 Final.doc	No	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 140	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	140	0	0	0	0	0
Annual IC Time Burden (Hours)	40	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
BHPR Funding Strategy Evaluation Supporting Statement	BHPR-PCRE Funding Strategy Eval Project-FINAL Supporting Statement-12.14.10.rtf	12/14/2010
BHPR Funding Strategy Informational One-Pager	Evaluation Interview One-pager.docx	12/14/2010

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