Site Recruitment and Training

Health Center Patient Survey (HCPS_

OMB: 0915-0368

IC ID: 239085

Information Collection (IC) Details

View Information Collection (IC)

Site Recruitment and Training
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 2 Attachment10 National_Awardee and Site Recruitment Materials_3-23-20 Attachment10 National_Awardee and Site Recruitment Materials_final 10_29_2019_psg.docx Yes Yes Fillable Fileable

Health Health Care Services

 

700 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 700 0 700 0 0 0
Annual IC Time Burden (Hours) 2,205 0 2,205 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 13 Receptionist Recruitment Script_English_TChinese AT0E7D~1.DOC 12/26/2019
Attachment 13 Receptionist Recruitment Script_Spanish ATTACH~3.DOC 12/26/2019
Attachment 13 Receptionist Recruitment Script_Vietnamese ATTACH~1.DOC 12/26/2019
Attachment 13 Receptionist Recruitment Script_Tagalog AT8625~1.DOC 12/26/2019
Attachment 13 Interviewer Recruitment Script final_TChinese AT5587~1.DOC 12/26/2019
Attachment 13 Interviewer Recruitment Script final_Spanish ATTACH~2.DOC 12/26/2019
Attachment 13 Interviewer Recruitment Script final_Tagalog ATAF25~1.DOC 12/26/2019
Attachment 13 Interviewer Recruitment Script final_Vietnamese AT3EB9~1.DOC 12/26/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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