Information Collection

Workflow information Tracking System (WiTS) Climate Survey (OHR/OD)

IC 238186 under ICR 202102-0925-005 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Workflow information Tracking System (WiTS) Climate Survey (OHR/OD)	Form
1 2019 WiTS Climate survey 2019 WiTS Climate Survey questions.pdf	Form
1 2019 WiTS Climate survey 2019 WiTS Climate Survey questions.pdf	Form
FastTrackforWiTSSurvey2019.docx Fast track WiTS Survey 2019	IC Document
FastTrackforWiTSSurvey2019.docx Fast track WiTS Survey 2019	IC Document
WiTS Climate Survey invitation email Nov 2019.docx WiTS Climate survey email invitation	IC Document
WiTS Climate Survey invitation email Nov 2019.docx WiTS Climate survey email invitation	IC Document

IC Title:

Workflow information Tracking System (WiTS) Climate Survey (OHR/OD)

Agency IC Tracking Number:

IC Status: Unchanged

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	2019 WiTS Climate survey	2019 WiTS Climate Survey questions.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 857

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	857	857
Annual IC Time Burden (Hours)	71	71
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast track WiTS Survey 2019	FastTrackforWiTSSurvey2019.docx	10/17/2019
WiTS Climate survey email invitation	WiTS Climate Survey invitation email Nov 2019.docx	10/17/2019

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