HRSA Electronic Handbooks Customer Service Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

IC Title:	HRSA Electronic Handbooks Customer Service Survey	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	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 %

	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

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.