Information Collection Request
Be the Match® Patient Services Survey
ICR 202306-0906-001 · OMB 0906-0004 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0906-0004 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 1 Patient Services Survey |
Form and Instruction | Modified | Repair queued |
 01232023 Email Invite Spanish - OPA Patient Support Center Survey OMB 0906-0004.docx |
Supplementary Document | Uploaded 2023-06-14 | Repair queued |
| 01232023 Email Invite English - OPA Patient Support Center Survey OMB 0906-0004.docx |
Supplementary Document | Uploaded 2023-06-14 | Repair queued |
| 06012023 - Supporting Statement A - OPA PSC Survey - OMB 0906-0004.docx |
Supporting Statement A | Uploaded 2023-06-14 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 213555 |  Patient Services Survey |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/HRSA |
| OMB Control No | 0906-0004 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202008-0906-002 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |