OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Center Workforce Well-Being Survey: Cognitive Sessions

IC 246086 under ICR 202004-0915-007 · OMB 0915-0379.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 1
Cognitive Interview Informed Consent Health Center Workforce Well-Being Survey: Cognitive Sessions		 Form and Instruction
1 Cognitive Interview Informed Consent
Cognitive Interview Informed Consent_1.6.2020 Submission.docx 		Form and Instruction
Cognitive Interview Supporting Statement A_1.6.2020 Submission.docx
Supporting Statement A		IC Document
Cognitive Interview Supporting Statement B 12292020.docx
Supporting Statement B		IC Document
HRSA Survey Draft V4__2.16.21 FINAL.docx
HRSA Survey Draft		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 and Instruction 1 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 60 0 60 0 0 0
Annual IC Time Burden (Hours) 90 0 90 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Supporting Statement A 03/03/2021
Supporting Statement B 03/03/2021
HRSA Survey Draft 03/03/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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