Information Collection

HRSA Office of Regional Operations (ORO) Outreach & Education Generic Survey Tool

IC 226674 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⚠️ Notice: This information collection may be referencing outdated material.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 Office of Regional Operations (ORO) Outreach & Education Generic Survey Tool	Form
1 ORO Generic Evaluation Survey January 2017 - FINAL DRAFT InstrumentORO Generic Evaluation Survey January 2017 - FINAL DRAFT.docx	Form
Supporting StatementORO Outreach Educ Generic Tool Supporting Statement 4.13.17.docx Supporting Statement	IC Document

IC Title:

HRSA Office of Regional Operations (ORO) Outreach & Education Generic Survey Tool

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	ORO Generic Evaluation Survey January 2017 - FINAL DRAFT.docx	InstrumentORO Generic Evaluation Survey January 2017 - FINAL DRAFT.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	501	501
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Supporting StatementORO Outreach Educ Generic Tool Supporting Statement 4.13.17.docx	05/03/2017

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