Information Collection

Stakeholder Experience of HHS Regional Service Delivery

IC 234891 under ICR 201703-0990-003 · OMB 0990-0459.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0459 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0459 ORP Survey Questions_2-11-19.docx	Other-survey
Presentation1 - original ORP survey submission Feb 2019.pdf	Other-Screenshots
0990-0459 Fast Track MEMO ORP Stateholder Engagement Request -v 2.docx memo	IC Document

IC Title:

Stakeholder Experience of HHS Regional Service Delivery

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-Screenshots			Presentation1 - original ORP survey submission Feb 2019.pdf		Yes	Yes	Fillable Fileable Signable
Other-survey			0990-0459 ORP Survey Questions_2-11-19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	400	400
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
memo	0990-0459 Fast Track MEMO ORP Stateholder Engagement Request -v 2.docx	02/12/2019

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