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HRSA Division of Transplantation (DoT) Concept Testing
Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0990-0379
IC ID: 254221
OMB.report
HHS/HHSDM
OMB 0990-0379
ICR 202206-0990-003
IC 254221
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:
2024-07-08 - No material or nonsubstantive change to a currently approved collection
2024-02-28 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
HRSA Division of Transplantation (DoT) Concept Testing
Form and Instruction
04112022 - Attachment 2 - DoT Concept Testing Screener - CLEAN.docx
Instruction
04112022 - Attachment 2 - DoT Concept Testing Screener - CLEAN.docx
Instruction
04112022 - Attachment 3 - DoT Concept Testing Online Focus Group Guide - CLEAN.docx
Instruction
04112022 - Attachment 3 - DoT Concept Testing Online Focus Group Guide - CLEAN.docx
Instruction
1 Informed Consent: DoT Concept Testing
04112022 - Attachment 1 - DoT Concept Testing Informed Consent - CLEAN.docx
Form and Instruction
1 Informed Consent: DoT Concept Testing
04112022 - Attachment 1 - DoT Concept Testing Informed Consent - CLEAN.docx
Form and Instruction
Fast Track Memo - Living Donation Materials Testing - OMB.docx
Fast Track Memo
IC Document
Fast Track Memo - Living Donation Materials Testing - OMB.docx
Fast Track Memo
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HRSA Division of Transplantation (DoT) Concept Testing
Agency IC Tracking Number:
IC Status:
Unchanged
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
1
Informed Consent: DoT Concept Testing
04112022 - Attachment 1 - DoT Concept Testing Informed Consent - CLEAN.docx
Yes
Yes
Fillable Fileable
Instruction
04112022 - Attachment 2 - DoT Concept Testing Screener - CLEAN.docx
Yes
Yes
Fillable Fileable
Instruction
04112022 - Attachment 3 - DoT Concept Testing Online Focus Group Guide - CLEAN.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
60
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
60
0
0
0
0
60
Annual IC Time Burden (Hours)
105
0
0
0
0
105
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Fast Track Memo
Fast Track Memo - Living Donation Materials Testing - OMB.docx
06/14/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.