OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Center Survey and Interviews

IC 231479 under ICR 201504-0990-001 · OMB 0990-0391.

Documents and Forms
Document Name
Document Type
Other-survey
Other-discussion
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Health Center Survey and Interviews
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 0990-0391 ASPR TRACIE Health Center Attachment A - Survey_5_17_18.doc Yes Yes Fillable Fileable
Other-discussion 0990-0391 ASPR TRACIE Health Center Attachment B - Interview Discussion Guide_5.17.18.doc Yes Yes Fillable Fileable

Health Health Care Services

 

250 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 250 0 250 0 0 0
Annual IC Time Burden (Hours) 75 0 75 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement SSA_0990-0391 Generic ASPR TRACIE Health Center Interviews 5-17-18.docx 05/17/2018
SS-B SSB_0990-0391 Generic ASPR TRACIE Health Center Interviews 5-17-18.docx 05/17/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.