Information Collection

Health Center Survey and Interviews

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Health Center Survey and Interviews

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.