Information Collection

2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2015 756 VBA Insurance Overall Questionnaire

IC 218255 under ICR 201412-1090-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 754 2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire 2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2015 756 VBA Insurance Overall Questionnaire	Form and Instruction
Form 755 2015 755 HRSA HAB - ART Survey 2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2015 756 VBA Insurance Overall Questionnaire	Form and Instruction
Form 756 2015 756 VBA Insurance Overall Questionnaire 2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2015 756 VBA Insurance Overall Questionnaire	Form and Instruction
754 2015 754 HRSA HAB CAREWare Customer Satisfaction and Use 2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire.docx	Form and Instruction
755 2015 755 HRSA HAB - ART Survey 2015 755 HRSA HAB - ART Survey.docx	Form and Instruction
756 2015 756 VBA Insurance Overall Questionnaire 2015 756 VBA Insurance Overall Questionnaire.docx	Form and Instruction

IC Title:

2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2015 756 VBA Insurance Overall Questionnaire

Agency IC Tracking Number:

754 - 756

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	754	Yes	Yes	Fillable Fileable
Form and Instruction	755	Yes	Yes	Fillable Fileable
Form and Instruction	756	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: 750

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 Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	188	188
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.

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