Information Collection

HRSA Electronic Handbooks Customer Service Survey

IC 226290 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⚠️ Notice: This information collection may be referencing outdated material.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 Electronic Handbooks Customer Service Survey	Form
1 HRSA EHBs Survey Screenshot HRSA EHBs Survey Screenshot.docx	Form
FINALHRSA EHBs Survey Supporting Statement Final 031317.docx Supporting Statement	IC Document

IC Title:

HRSA Electronic Handbooks Customer Service Survey

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	HRSA EHBs Survey Screenshot	HRSA EHBs Survey Screenshot.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,825

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,825	4,825
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	FINALHRSA EHBs Survey Supporting Statement Final 031317.docx	04/05/2017

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