BPHC Customer Service Survey Helpline & Answers

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⚠️ Notice: This information collection may be referencing outdated material.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 BPHC Customer Service Survey Helpline & Answers Form
1 Survey Instrument Helpline Survey Instrument Helpline 08.16.16.pdf Form
2 Survey Instrument Answers Survey Instrument Answers 08.16.16.pdf Form
Survey Supporting Statement 08.16.16 sd.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	BPHC Customer Service Survey Helpline & Answers	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	Survey Instrument Helpline	Survey Instrument Helpline 08.16.16.pdf		Yes	Yes	Fillable Fileable
Form	2	Survey Instrument Answers	Survey Instrument Answers 08.16.16.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,315	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,315	2,315
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Survey Supporting Statement 08.16.16 sd.docx	08/25/2016

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