Information Collection

HRSA BPHC 2018 Stakeholder Satisfaction Survey

IC 233060 under ICR 201805-1090-002 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 020 HRSA BPHC 2018 Stakeholder Satisfaction Survey	Form and Instruction
020 HRSA BPHC 2018 Stakeholder Satisfaction Survey 2018 020 HRSA BPHC Stakeholder Satisfaction Survey Questionnaire.Final to OMB (1).docx	Form and Instruction
OMB Mapping Cover_HRSA BPHC Satisfaction Survey # 020.xlsx HRSA BPHC 2018 Stakeholder Satisfaction Survey	IC Document
Request for approval form.pdf HRSA Stakeholder Satisfaction Survey	IC Document

IC Title:

HRSA BPHC 2018 Stakeholder Satisfaction Survey

Agency IC Tracking Number:

020

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
Form and Instruction	020	HRSA BPHC 2018 Stakeholder Satisfaction Survey	2018 020 HRSA BPHC Stakeholder Satisfaction Survey Questionnaire.Final to OMB (1).docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	250	250
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HRSA BPHC 2018 Stakeholder Satisfaction Survey	OMB Mapping Cover_HRSA BPHC Satisfaction Survey # 020.xlsx	09/18/2018
HRSA Stakeholder Satisfaction Survey	Request for approval form.pdf	09/18/2018

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