Information Collection

HPP Partner Community Survey

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HPP Partner Community Survey	Agency IC Tracking Number:

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
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 %

	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

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.