Information Collection

HP Survey 2021

IC 256687 under ICR 202210-0906-004 · OMB 0906-0074.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0074 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HP Survey 2021	Form and Instruction
1 HP Survey Attachment B1 - HP Survey1 - Copy.docx	Form and Instruction
1 HP Survey Attachment B1 - HP Survey1 - Copy.docx	Form and Instruction

IC Title:

HP Survey 2021

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	HP Survey	Attachment B1 - HP Survey1 - Copy.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,031

Number of Respondents for Small Entity: 8,029

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,031	8,031
Annual IC Time Burden (Hours)	6,023	6,023
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.