Information Collection

HRSA Survey Assessment of Objective Peer Review

IC 217944 under ICR 201502-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.