Site Recruitment and Training

Health Center Patient Survey (HCPS)

OMB: 0915-0368

IC ID: 239085

Documents and Forms

Document Name Document Type
Form 2 Site Recruitment and Training Form
2 Attachment10 National_Awardee and Site Recruitment Mater Attachment10 National_Awardee and Site Recruitment Materials_final 10_29_2019_psg.docx Form
2 Attachment10 National_Awardee and Site Recruitment Mater Attachment10 National_Awardee and Site Recruitment Materials_final 10_29_2019_psg.docx Form
Receptionist Recruitment Script_Phone_version.docx Receptionist Recruitment Script_Phone_version IC Document
Receptionist Recruitment Script_Phone_version.docx Receptionist Recruitment Script_Phone_version IC Document
Receptionist Recruitment Script_English_TChinese_psg.docx Receptionist Recruitment Script_Chinese_psg IC Document
Receptionist Recruitment Script_English_TChinese_psg.docx Receptionist Recruitment Script_Chinese_psg IC Document
Receptionist Recruitment Script_Spanish_psg.docx Receptionist Recruitment Script_Spanish_psg IC Document
Receptionist Recruitment Script_Spanish_psg.docx Receptionist Recruitment Script_Spanish_psg IC Document
Receptionist Recruitment Script_Viet_psg.docx Receptionist Recruitment Script_Viet_psg IC Document
Receptionist Recruitment Script_Viet_psg.docx Receptionist Recruitment Script_Viet_psg IC Document
Interviewer Recruitment Script final_Phone_version.docx Interviewer Recruitment Script final_Phone_version IC Document
Interviewer Recruitment Script final_Phone_version.docx Interviewer Recruitment Script final_Phone_version IC Document
Interviewer Recruitment Script final_TChinese_Phone.docx Interviewer Recruitment Script final_TChinese_Phone IC Document
Interviewer Recruitment Script final_TChinese_Phone.docx Interviewer Recruitment Script final_TChinese_Phone IC Document
Phone Version Interviewer Recruitment Script final_Spanish_psg.docx Phone Version Interviewer Recruitment Script final_Spanish_psg IC Document
Phone Version Interviewer Recruitment Script final_Spanish_psg.docx Phone Version Interviewer Recruitment Script final_Spanish_psg IC Document
Interviewer Recruitment Script final VIET_psg.docx Interviewer Recruitment Script final VIET_psg IC Document
Interviewer Recruitment Script final VIET_psg.docx Interviewer Recruitment Script final VIET_psg IC Document
Attachment 13 Receptionist Recruitment Script at clinic Tagalog_psg.docx Attachment 13 Receptionist Recruitment Script at clinic Tagalog_psg IC Document
Attachment 13 Receptionist Recruitment Script at clinic Tagalog_psg.docx Attachment 13 Receptionist Recruitment Script at clinic Tagalog_psg IC Document
Attachment 13 Interviewer Recruitment Script_Tagalog_psg.docx Attachment 13 Interviewer Recruitment Script_Tagalog_psg IC Document
Attachment 13 Interviewer Recruitment Script_Tagalog_psg.docx Attachment 13 Interviewer Recruitment Script_Tagalog_psg IC Document
Flyer to Hand to Patients.docx Flyer to Hand to Patients IC Document
Flyer to Hand to Patients.docx Flyer to Hand to Patients IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Site Recruitment and Training	Agency IC Tracking Number:

Is this a Common Form? No		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	2	Attachment10 National_Awardee and Site Recruitment Materials_3-23-20	Attachment10 National_Awardee and Site Recruitment Materials_final 10_29_2019_psg.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	2,205	2,205
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Receptionist Recruitment Script_Phone_version	Receptionist Recruitment Script_Phone_version.docx	12/11/2020
Receptionist Recruitment Script_Chinese_psg	Receptionist Recruitment Script_English_TChinese_psg.docx	12/11/2020
Receptionist Recruitment Script_Spanish_psg	Receptionist Recruitment Script_Spanish_psg.docx	12/11/2020
Receptionist Recruitment Script_Viet_psg	Receptionist Recruitment Script_Viet_psg.docx	12/11/2020
Interviewer Recruitment Script final_Phone_version	Interviewer Recruitment Script final_Phone_version.docx	12/11/2020
Interviewer Recruitment Script final_TChinese_Phone	Interviewer Recruitment Script final_TChinese_Phone.docx	12/11/2020
Phone Version Interviewer Recruitment Script final_Spanish_psg	Phone Version Interviewer Recruitment Script final_Spanish_psg.docx	12/11/2020
Interviewer Recruitment Script final VIET_psg	Interviewer Recruitment Script final VIET_psg.docx	12/11/2020
Attachment 13 Receptionist Recruitment Script at clinic Tagalog_psg	Attachment 13 Receptionist Recruitment Script at clinic Tagalog_psg.docx	12/11/2020
Attachment 13 Interviewer Recruitment Script_Tagalog_psg	Attachment 13 Interviewer Recruitment Script_Tagalog_psg.docx	12/11/2020
Flyer to Hand to Patients	Flyer to Hand to Patients.docx	12/11/2020

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