Information Collection

502 HRSA BCRS NHSC Participant Survey

IC 204060 under ICR 201209-1090-001 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 502 502 HRSA BCRS NHSC Participant Survey	Form and Instruction
502 HRSA BCRS NHSC Participant Survey 2012 502 HRSA BCRS NHSC 2011 Participant Questionnaire_FINAL_051112.docx	Form and Instruction

IC Title:

502 HRSA BCRS NHSC Participant Survey

Agency IC Tracking Number:

502

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	502	HRSA BCRS NHSC Participant Survey	2012 502 HRSA BCRS NHSC 2011 Participant Questionnaire_FINAL_051112.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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