Health Center Survey and Interviews

The Hospital Preparedness Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0391 can be found here:

Documents and Forms

Document Name Document Type
0990-0391 ASPR TRACIE Health Center Attachment A - Survey_5_17_18.doc Other-survey
0990-0391 ASPR TRACIE Health Center Attachment B - Interview Discussion Guide_5.17.18.doc Other-discussion
SSA_0990-0391 Generic ASPR TRACIE Health Center Interviews 5-17-18.docx Supporting Statement IC Document
SSB_0990-0391 Generic ASPR TRACIE Health Center Interviews 5-17-18.docx SS-B IC Document

Information Collection (IC) Details

IC Title:	Health Center Survey and Interviews	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
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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	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	250	250
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.