Information Collection

HRSA HAB Recipeint Questionnaire-061 20316 A1

IC 237238 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⚠️ Notice: This information collection may be referencing outdated material.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 061-20316 A1 HRSA HAB Recipeint Questionnaire-061 20316 A1	Form and Instruction
061-20316 A1 HRSA HAB Recipient Questionnaire HRSA HAB Recipient Questionnaire -.docx	Form and Instruction
1090-0007 Generic Clearance Request Form-signed.pdf Generic Clearance Request Form	IC Document
HRSA HAB Recipient 2019 OMB Mapping Document.xlsx OMB Mapping form	IC Document

IC Title:

HRSA HAB Recipeint Questionnaire-061 20316 A1

Agency IC Tracking Number:

061-20316A1

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	061-20316 A1	HRSA HAB Recipient Questionnaire	HRSA HAB Recipient Questionnaire -.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
Generic Clearance Request Form	1090-0007 Generic Clearance Request Form-signed.pdf	08/02/2019
OMB Mapping form	HRSA HAB Recipient 2019 OMB Mapping Document.xlsx	08/02/2019

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