DIR Objective Peer Review Assessment Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

OMB: 0915-0212

IC ID: 232505

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Instruction
Instruction
Form and Instruction
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Information Collection (IC) Details

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DIR Objective Peer Review Assessment Survey
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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

Health Health Care Services

 

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

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