Health Center Program Support (HCPS) Customer Service Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

OMB: 0915-0212

IC ID: 248514

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Document Name
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Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

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Health Center Program Support (HCPS) Customer Service Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 HCPS - 2021 Sample Customer Service Survey--Salesforce In Sandbox.docx HCPS - 2021 Sample Customer Service Survey--Salesforce In Sandbox.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

800 0
   
Private Sector Not-for-profit institutions
 
   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 800 0 0 0 0 800
Annual IC Time Burden (Hours) 40 0 0 0 0 40
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GENERIC - Supporting Statement_BPHC Customer Service Survey-HCPS 2021 GENERIC - Supporting Statement_BPHC Customer Service Survey-HCPS 2021.docx 07/26/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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