Health Center Workforce Well-Being Survey: Listening Sessions

Questionnaire and Data Collection Testing, Evaluation, and Research for the Health Resources and Services Administration (HRSA)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Listening Session Consent Form revised July 6.docx	Listening Session Consent Form revised July 6.docx		Yes	Yes	Fillable Fileable
Other-SLIDE DECK			Leadership Listening Session Deck revised 3-23-2020 approved July 6.pptx		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 %

	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

Title	Document	Date Uploaded
Listening Session Supporting Statement A_	Listening Session Supporting Statement A_081020_CLEAN2.docx	08/18/2020
Listening Session Supporting Statement B_with revisions July 6	Listening Session Supporting Statement B_with revisions July 6.docx	08/18/2020

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