Information Collection

Diverse Voices Speaker Series Feedback Form (ORWH/OD)

IC 245504 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⚠️ Notice: This information collection may be referencing outdated material.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 Diverse Voices Speaker Series Feedback Form (ORWH/OD)	Form
1 Diverse Voices Speaker Series Diverse Voices Speaker Series Instrument (1).docx	Form
1 Diverse Voices Speaker Series Diverse Voices Speaker Series Instrument (1).docx	Form
Diverse Voices feedback submission_2 (1).docx fast track Diverse Voices Speaker Series Feedback	IC Document
Diverse Voices feedback submission_2 (1).docx fast track Diverse Voices Speaker Series Feedback	IC Document

IC Title:

Diverse Voices Speaker Series Feedback Form (ORWH/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	Diverse Voices Speaker Series	Diverse Voices Speaker Series Instrument (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

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	600	600
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track Diverse Voices Speaker Series Feedback	Diverse Voices feedback submission_2 (1).docx	02/01/2021

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