Information Collection

HRSA Health Center Workforce Survey: Cognitive Interviews

IC 260919 under ICR 202306-0915-006 · OMB 0915-0379.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HRSA Health Center Workforce Survey: Cognitive Interviews	Form
1 Cognitive Interview Informed Consent Cognitive Interview Informed Consent_1.6.2020 Submission.docx	Form
1 Cognitive Interview Informed Consent Cognitive Interview Informed Consent_1.6.2020 Submission.docx	Form
Cognitive Interview Supporting Statement A_1.6.2020 Submission.docx Supporting Statement A	IC Document
Cognitive Interview Supporting Statement A_1.6.2020 Submission.docx Supporting Statement A	IC Document
Cognitive Interview Supporting Statement B 12292020.docx Supporting Statement B	IC Document
Cognitive Interview Supporting Statement B 12292020.docx Supporting Statement B	IC Document
HRSA Survey Draft V4__2.16.21 FINAL.docx HRSA Survey Draft	IC Document
HRSA Survey Draft V4__2.16.21 FINAL.docx HRSA Survey Draft	IC Document

IC Title:

Agency IC Tracking Number:

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	1	Cognitive Interview Informed Consent	Cognitive Interview Informed Consent_1.6.2020 Submission.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 60

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	Cognitive Interview Supporting Statement A_1.6.2020 Submission.docx	06/29/2023
Supporting Statement B	Cognitive Interview Supporting Statement B 12292020.docx	06/29/2023
HRSA Survey Draft	HRSA Survey Draft V4__2.16.21 FINAL.docx	06/29/2023

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