Information Collection

SR Maximizing Value 3Month Post (ORS/OD)

IC 236484 under ICR 202104-0925-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 SR Maximizing Value 3Month Post (ORS/OD)	Form and Instruction
1 KOliver Screenshots 061119-KOliver-SCREENSHOTS-Maximizing Value Pilot-3MonthPostTrainEvalSurvey.docx	Form and Instruction
1 KOliver Screenshots 061119-KOliver-SCREENSHOTS-Maximizing Value Pilot-3MonthPostTrainEvalSurvey.docx	Form and Instruction
061119-KOliver-Fast Track PRA Request for Approval-3MoPostSurv.doc Fast Track fir Mazimizing Value 3Mo Post	IC Document
061119-KOliver-Fast Track PRA Request for Approval-3MoPostSurv.doc Fast Track fir Mazimizing Value 3Mo Post	IC Document

IC Title:

SR Maximizing Value 3Month Post (ORS/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 and Instruction	1	KOliver Screenshots	061119-KOliver-SCREENSHOTS-Maximizing Value Pilot-3MonthPostTrainEvalSurvey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track fir Mazimizing Value 3Mo Post	061119-KOliver-Fast Track PRA Request for Approval-3MoPostSurv.doc	06/13/2019

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