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

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.