Information Collection

HPP Partner Community Survey

IC 234995 under ICR 201807-0990-004 · OMB 0990-0391.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
For PRA Approval - HPP Partner Survey Questions_1.7.2019_v1 (002).DOCX	Other-Survey Questions and Instructi
For PRA Approval - Memo Template_HPP Partner Survey_1.7.2019_v1 (002).DOC HPP Partner Community Survey	IC Document

IC Title:

Agency IC Tracking Number:

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
Other-Survey Questions and Instructions			For PRA Approval - HPP Partner Survey Questions_1.7.2019_v1 (002).DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 210

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	210	210
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HPP Partner Community Survey	For PRA Approval - Memo Template_HPP Partner Survey_1.7.2019_v1 (002).DOC	02/19/2019

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