Information Collection

NEHEP Partnership Summit Surveys (NEI)

IC 258479 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NEHEP Partnership Summit Surveys (NEI)	Form
1 Pre-Summit Survey NEI_NEHEP_PreSummit_FinalSurvey_2023.02.09_CLEAN.docx	Form
2 Post-Summit Survey instrument NEI_NEHEP_PostSummit_FinalSurvey_2023.02.08_CLEAN.docx	Form
OMB Fast Track Form_NEHEP Partnership Summit 2023 Surveys_2023.01.20 (4).docx fast track for NEHEP Pre-Post Summit surveys	IC Document
NEI_NEHEP Partnership Summit Survey_OutreachEmails_2023.02.08.docx outreach emails	IC Document

IC Title:

NEHEP Partnership Summit Surveys (NEI)

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	1	Pre-Summit Survey	NEI_NEHEP_PreSummit_FinalSurvey_2023.02.09_CLEAN.docx		Yes	Yes	Fillable Fileable
Form	2	Post-Summit Survey instrument	NEI_NEHEP_PostSummit_FinalSurvey_2023.02.08_CLEAN.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track for NEHEP Pre-Post Summit surveys	OMB Fast Track Form_NEHEP Partnership Summit 2023 Surveys_2023.01.20 (4).docx	02/10/2023
outreach emails	NEI_NEHEP Partnership Summit Survey_OutreachEmails_2023.02.08.docx	02/16/2023

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