Information Collection

SRA Tool User Experience Survey

IC 247640 under ICR 202101-0955-001 · OMB 0955-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0955-0003 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 SRA Tool User Experience Survey SRA Tool User Experience Survey	Form
1 SRA Tool User Experience Survey SRA Tool User Experience Survey.pdf	Form
0955-0003 MEMO SRA_Tool.docx Memo for SRA Tool User Experience Survey	IC Document
Survey welcome screen with burden statement.JPG Survey welcome and burden	IC Document

IC Title:

SRA Tool User Experience Survey

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, 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	5,000	5,000
Annual IC Time Burden (Hours)	833	833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo for SRA Tool User Experience Survey		06/07/2021
Survey welcome and burden		06/07/2021

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

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