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HRSA Health Center Workforce Survey: Cognitive Interviews
Questionnaire and Data Collection Testing, Evaluation, and Research for the Health Resources and Services Administration (HRSA)
OMB: 0915-0379
IC ID: 260919
OMB.report
HHS/HSA
OMB 0915-0379
ICR 202306-0915-006
IC 260919
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HRSA Health Center Workforce Survey: Cognitive Interviews
Agency IC Tracking Number:
IC Status:
New
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
1
Cognitive Interview Informed Consent
Cognitive Interview Informed Consent_1.6.2020 Submission.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:
60
Number of Respondents for Small Entity:
60
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
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
60
0
0
0
Annual IC Time Burden (Hours)
90
0
90
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.