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Federal forms, ICRs, and supporting documents

Information Collection

DIR Objective Review Assessment Survey

IC 247769 under ICR 202308-0915-005 · OMB 0915-0212.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Other-Public Burden Screenshot
Other-Public Burden Screenshot
Form
Form
Form
Form
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

DIR Objective Review Assessment Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction DIR Review Assessment Survey form 1 - screenshot Reviewer instructions 3-8-2021.pdf Yes Yes Fillable Fileable
Form 1 Reviewer Evaluation Q 1- 15.pdf FORM Reviewer Evaluation Q 1- 15.pdf Yes Yes Fillable Fileable
Form 1.2 Reviewer Evaluation-Field Review Q 1 - 12.pdf FORM Reviewer Evaluation-Field Review Q 1 - 12.pdf Yes Yes Fillable Fileable
Form and Instruction 2 FORM CHAIR Q 1-5.pdf FORM CHAIR Q 1-5.pdf Yes Yes Fillable Fileable
Other-Public Burden Screenshot Public Burden Statement Screenshot.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,300 0
   
State, Local, and Tribal Governments
 
   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 2,300 0 0 0 0 2,300
Annual IC Time Burden (Hours) 575 0 0 0 0 575
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A - DIR Review Assessment Survey Supporting Statement A - DIR Review Assessment Survey.docx 06/04/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.