Information Collection

Strategic Plan Survey (ORA)

IC 239379 under ICR 201710-0910-006 · OMB 0910-0697.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0697 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix I - Survey Tool.docx	Other-Survey Instrument
Appendix II - Survey Tool Snapshot.docx	Other-Screenshot
Appendix III - View After Submitting Survey.docx	Other-Screenshot
Appendix IV - Customer List.docx	Other-Customer List
0697 OMB Approval Memo - Strategic Plan Development Survey 2020.docx OMB approval memo	IC Document

IC Title:

Strategic Plan Survey (ORA)

Agency IC Tracking Number:

ORA

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Instrument	Appendix I - Survey Tool.docx	Yes	Yes	Fillable Fileable
Other-Screenshot	Appendix II - Survey Tool Snapshot.docx	Yes	Yes	Fillable Fileable
Other-Screenshot	Appendix III - View After Submitting Survey.docx	Yes	No	Printable Only
Other-Customer List	Appendix IV - Customer List.docx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

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	80	80
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB approval memo	0697 OMB Approval Memo - Strategic Plan Development Survey 2020.docx	01/22/2020

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