HRSA HHS NHSC Participant Stakeholder

American Customer Satisfaction Index "Customer Satisfaction Surveys"

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 023-20317 A1 HRSA HHS NHSC Participant Stakeholder Form and Instruction
023-20317 A1 NHSC HRSA Participant Survey-023-20317 A1 NHSC 2018 Participant Survey_IA 20317.xlsx Form and Instruction
1090-0007 Generic Clearance Request Form HRSA Participants_IA 20317 A1-.pdf 20317 A1 IC Document
OMB Mapping HRSA NHSC Participant Survey 20317 A1.xlsx 20317 A1 IC Document

Information Collection (IC) Details

IC Title:	HRSA HHS NHSC Participant Stakeholder	Agency IC Tracking Number:	023-20317 A1

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	023-20317 A1	NHSC HRSA Participant Survey-023-20317 A1	NHSC 2018 Participant Survey_IA 20317.xlsx		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 %

	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

Title	Document	Date Uploaded
20317 A1	1090-0007 Generic Clearance Request Form HRSA Participants_IA 20317 A1-.pdf	10/03/2018
20317 A1	OMB Mapping HRSA NHSC Participant Survey 20317 A1.xlsx	10/03/2018

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