Regugee Health Coordinator Survey

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Regugee Health Coordinator Survey Form and Instruction
1 Survey of Refugee Health Coordinators Survey of Refugee Health Coordinators.docx Form and Instruction
RHC Survey Fast Track.doc Justification IC Document

Information Collection (IC) Details

IC Title:	Regugee Health Coordinator 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 and Instruction	1	Survey of Refugee Health Coordinators	Survey of Refugee Health Coordinators.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification	RHC Survey Fast Track.doc	01/31/2018

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