Information Collection

Health Center Workforce Well-Being Survey: Listening Sessions

IC 243215 under ICR 202004-0915-007 · OMB 0915-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Listening Session Consent Form revised July 6.docx Health Center Workforce Well-Being Survey: Listening Sessions	Form
Leadership Listening Session Deck revised 3-23-2020 approved July 6.pptx	Other-SLIDE DECK
1 Listening Session Consent Form revised July 6.docx Listening Session Consent Form revised July 6.docx	Form
Listening Session Supporting Statement A_081020_CLEAN2.docx Listening Session Supporting Statement A_	IC Document
Listening Session Supporting Statement B_with revisions July 6.docx Listening Session Supporting Statement B_with revisions July 6	IC Document

IC Title:

Health Center Workforce Well-Being Survey: Listening Sessions

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
Form	1				Yes	Yes	Fillable Fileable
Other-SLIDE DECK					Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 60

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	60	60
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Listening Session Supporting Statement A_		08/18/2020
Listening Session Supporting Statement B_with revisions July 6		08/18/2020

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

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