HRSA Survey Assessment of Objective Peer Review

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⚠️ Notice: This information collection may be referencing outdated material.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 1 HRSA Survey Assessment of Objective Peer Review Form
1 Reviewer Survey DIR Screen Shots Reviewer Survey Form 1.docx Form
2 Chair Survey DIR Screen Shots Chair Survey Form 2.docx Form
DIR Supporting Statement.docx DIR Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	HRSA Survey Assessment of Objective Peer Review	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
Form	1	Reviewer Survey	DIR Screen Shots Reviewer Survey Form 1.docx		Yes	Yes	Fillable Fileable
Form	2	Chair Survey	DIR Screen Shots Chair Survey Form 2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,158	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,158	2,158
Annual IC Time Burden (Hours)	540	540
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
DIR Supporting Statement	DIR Supporting Statement.docx	08/20/2015

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