OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Dr. Sano's Weekly Pulse Survey (CC)

IC 256908 under ICR 202307-0925-002 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

2024-06-25 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Dr. Sano's Weekly Pulse Survey (CC)	Form and Instruction
1 Survey Weekly Pulse Survey screen .png	Form and Instruction
Email for 2022 Weekly Pulse Survey (1).pdf Recruitment Email	IC Document
Template -- Sano Pulse Survey rev4.docx Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Dr. Sano's Weekly Pulse Survey (CC)

Agency IC Tracking Number:

IC Status: Unchanged

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	Survey	Weekly Pulse Survey screen .png		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: 55

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	55	0	0	0	0	55
Annual IC Time Burden (Hours)	2	0	0	0	0	2
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Recruitment Email	Email for 2022 Weekly Pulse Survey (1).pdf	11/15/2022
Template	Template -- Sano Pulse Survey rev4.docx	11/15/2022

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