HITRC Training Three Month Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (HITRC)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0003 can be found here:

Documents and Forms

Document Name Document Type
0990-0003_Attachment A - HITRC Training Three Month Survey_020613.docx Other-survey
0955-0003 Attachment B - Survey E-mail Invitation_020613.docx Other-survey
0955-0003 Submission Form - HITRC Training Three Month Survey 020613.docx 0955-0003 Submission Form - HITRC Training Three Month Survey 020613 IC Document

Information Collection (IC) Details

IC Title:	HITRC Training Three Month Survey	Agency IC Tracking Number:

IC Status: New

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
Other-survey			0990-0003_Attachment A - HITRC Training Three Month Survey_020613.docx		No	No	Paper Only
Other-survey			0955-0003 Attachment B - Survey E-mail Invitation_020613.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 825	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	825	0	0	0	0	0
Annual IC Time Burden (Hours)	28	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0955-0003 Submission Form - HITRC Training Three Month Survey 020613	0955-0003 Submission Form - HITRC Training Three Month Survey 020613.docx	03/01/2013

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