OAMP Customer Satisfaction Survey

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 OAMP Customer Satisfaction Survey Form
1 Example Survey in Survey Monkey - OAMP.pdf Example Survey in Survey Monkey - OAMP.pdf Form
HRSA-OAMP Customer Satisfaction Survey Supporting Statement 6-23-20 EDITED.docx SS A IC Document

Information Collection (IC) Details

IC Title:	OAMP Customer Satisfaction Survey	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
Form	1	Example Survey in Survey Monkey - OAMP.pdf	Example Survey in Survey Monkey - OAMP.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 197	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	985	985
Annual IC Time Burden (Hours)	246	246
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SS A	HRSA-OAMP Customer Satisfaction Survey Supporting Statement 6-23-20 EDITED.docx	07/01/2020

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