Information Collection

National Health Service Corps (NHSC) Virtual Job Fair Customer Feedback

IC 203969 under ICR 201206-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1 National Health Service Corps (NHSC) Virtual Job Fair Customer Feedback	Form and Instruction
1 Site Feedback Survey - Site Feedback.pdf	Form and Instruction
2 Participant Feedback Survey - Participant Feedback.pdf	Form and Instruction
Supporting Statement.docx Supporting Statement	IC Document

IC Title:

National Health Service Corps (NHSC) Virtual Job Fair Customer Feedback

Agency IC Tracking Number:

IC Status: New

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	1	Site Feedback	Survey - Site Feedback.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Participant Feedback	Survey - Participant Feedback.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	48	0	0	0	0	0
Annual IC Time Burden (Hours)	11	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting Statement.docx	09/06/2012

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