Information Collection

Staff Survey – Implementation Phase [Months 1, 3, 5]

IC 251470 under ICR 202202-0920-001 · OMB 0920-1379.

Documents and Forms

Document Name Document Type
Form 0920- Staff Survey – Implementation Phase [Months 1, 3, 5] Form and Instruction
0920- Staff Survey -- Implementation Phase (Months 1, 3, 5) Att 3b Staff Survey - Impl Phase 1,3,5.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Staff Survey â Implementation Phase [Months 1, 3, 5]	Agency IC Tracking Number:	0920-21HI

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-	Staff Survey -- Implementation Phase (Months 1, 3, 5)	Att 3b Staff Survey - Impl Phase 1,3,5.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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