NHSC Virtual Job Fair Customer Feedback

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⚠️ Notice: This information collection may be referencing outdated material.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 NHSC Virtual Job Fair Customer Feedback Form and Instruction
1 NHSC Virtual Job Fair SITES Feedback Questions.docx NHSC Virtual Job Fair SITES Feedback Questions.docx Form and Instruction
2 NHSC Virtual Job Fair PARTICIPANTS Feedback Questions.do NHSC Virtual Job Fair PARTICIPANTS Feedback Questions.docx Form and Instruction
3 NHSC Virtual Job Fair SITES Follow Up Feedback Questions NHSC Virtual Job Fair SITES Follow Up Feedback Questions.docx Form and Instruction
4 NHSC Virtual Job Fair PARTICIPANTS Follow Up Feedback Qu NHSC Virtual Job Fair PARTICIPANTS Follow Up Feedback Questions.docx Form and Instruction
OMB Supporting Statement VJF.DOCX Supporting Statment IC Document

Information Collection (IC) Details

IC Title:	NHSC Virtual Job Fair Customer Feedback	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	NHSC Virtual Job Fair SITES Feedback Questions.docx	NHSC Virtual Job Fair SITES Feedback Questions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	NHSC Virtual Job Fair PARTICIPANTS Feedback Questions.docx	NHSC Virtual Job Fair PARTICIPANTS Feedback Questions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	NHSC Virtual Job Fair SITES Follow Up Feedback Questions.docx	NHSC Virtual Job Fair SITES Follow Up Feedback Questions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	NHSC Virtual Job Fair PARTICIPANTS Follow Up Feedback Questions.docx	NHSC Virtual Job Fair PARTICIPANTS Follow Up Feedback Questions.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 96	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	96	96
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statment	OMB Supporting Statement VJF.DOCX	06/21/2017

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