HRSA HAB Recipeint Questionnaire-061 20316 A1

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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
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.