Information Collection

DIR Objective Peer Review Assessment Survey

IC 232505 under ICR 201506-0915-001 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 DIR Objective Peer Review Assessment Survey	Form and Instruction
DIR Review Assessment Survey form 1 - screenshot instructions.png	Instruction
DIR Review Assessment Survey form 2 - screenshot instructions.png	Instruction
1 0212 DIR OMB Survey Binder 8-1-18.pdf - SHOWS BURDEN STM 0212 DIR OMB Survey Binder 8-1-18.pdf	Form and Instruction
1Q1 DIR Review Assessment Survey form 1 - screenshot Reviwer DIR Review Assessment Survey form 1 - screenshot Reviwer Q1.png	Form
1Q2 DIR Review Assessment Survey form 1 - screenshot Reviewe DIR Review Assessment Survey form 1 - screenshot ReviewerQ2.png	Form
1Q3 DIR Review Assessment Survey form 1 - screenshot Reviwer DIR Review Assessment Survey form 1 - screenshot Reviwer3.png	Form
1Q4 DIR Review Assessment Survey form 1 - screenshot Reviwer DIR Review Assessment Survey form 1 - screenshot ReviwerQ4.png	Form
1Q5 DIR Review Assessment Survey form 1 - screenshot Reviwer DIR Review Assessment Survey form 1 - screenshot ReviwerQ5.png	Form
2Q1 DIR Review Assessment Survey form 2 - screenshot ChairQ DIR Review Assessment Survey form 2 - screenshot ChairQ 1.png	Form
2Q2 DIR Review Assessment Survey form 2 - screenshot Chair R DIR Review Assessment Survey form 2 - screenshot Chair ReviewQ2.png	Form
DIR Review Assessment Survey - Supporting Stmt_ 8-1-18 FINAL.doc Supporting Statement FINAL	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

DIR Objective Peer Review Assessment Survey

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	0212 DIR OMB Survey Binder 8-1-18.pdf - SHOWS BURDEN STMNT, OMB NO AND EXP DATE	0212 DIR OMB Survey Binder 8-1-18.pdf	Yes	Yes	Fillable Fileable
Instruction			DIR Review Assessment Survey form 1 - screenshot instructions.png	Yes	Yes	Fillable Fileable
Form	1Q1	DIR Review Assessment Survey form 1 - screenshot Reviwer Q1.png	DIR Review Assessment Survey form 1 - screenshot Reviwer Q1.png	Yes	Yes	Fillable Fileable
Form	1Q2	DIR Review Assessment Survey form 1 - screenshot ReviewerQ2.png	DIR Review Assessment Survey form 1 - screenshot ReviewerQ2.png	Yes	Yes	Fillable Fileable
Form	1Q3	DIR Review Assessment Survey form 1 - screenshot Reviwer3.png	DIR Review Assessment Survey form 1 - screenshot Reviwer3.png	Yes	Yes	Fillable Fileable
Form	1Q4	DIR Review Assessment Survey form 1 - screenshot ReviwerQ4.png	DIR Review Assessment Survey form 1 - screenshot ReviwerQ4.png	Yes	Yes	Fillable Fileable
Form	1Q5	DIR Review Assessment Survey form 1 - screenshot ReviwerQ5.png	DIR Review Assessment Survey form 1 - screenshot ReviwerQ5.png	Yes	Yes	Fillable Fileable
Instruction			DIR Review Assessment Survey form 2 - screenshot instructions.png	Yes	Yes	Fillable Fileable
Form	2Q1	DIR Review Assessment Survey form 2 - screenshot ChairQ 1.png	DIR Review Assessment Survey form 2 - screenshot ChairQ 1.png	Yes	Yes	Fillable Fileable
Form	2Q2	DIR Review Assessment Survey form 2 - screenshot Chair ReviewQ2.png	DIR Review Assessment Survey form 2 - screenshot Chair ReviewQ2.png	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,300

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	2,300	2,300
Annual IC Time Burden (Hours)	575	575
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement FINAL	DIR Review Assessment Survey - Supporting Stmt_ 8-1-18 FINAL.doc	08/01/2018

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