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Feedback and Lessons Learned from CBO Program Award Recipients
Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration
OMB: 0915-0212
IC ID: 259277
OMB.report
HHS/HSA
OMB 0915-0212
ICR 202308-0915-005
IC 259277
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:
2024-01-10 - Revision of a currently approved collection
2024-01-04 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
03212023 - CBO Tab B - Focus Group Guide OMB 0915-0212.docx
Instruction
03212023 - CBO Tab B - Focus Group Guide OMB 0915-0212.docx
Instruction
03152023 - CBO Tab C - Recruitment and Sampling Method OMB 0915-0212.docx
Instruction
03152023 - CBO Tab C - Recruitment and Sampling Method OMB 0915-0212.docx
Instruction
03152023 - CBO Tab D - Facilitator Recruitment Materials OMB 0915-0212.docx
Instruction
03152023 - CBO Tab D - Facilitator Recruitment Materials OMB 0915-0212.docx
Instruction
03152023 - CBO Tab A - Fast Track Memo - OMB 0915-0212.docx
Fast Track Memo
IC Document
03152023 - CBO Tab A - Fast Track Memo - OMB 0915-0212.docx
Fast Track Memo
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Feedback and Lessons Learned from CBO Program Award Recipients
Agency IC Tracking Number:
IC Status:
Unchanged
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
Instruction
03212023 - CBO Tab B - Focus Group Guide OMB 0915-0212.docx
Yes
Yes
Fillable Fileable
Instruction
03152023 - CBO Tab C - Recruitment and Sampling Method OMB 0915-0212.docx
Yes
Yes
Fillable Fileable
Instruction
03152023 - CBO Tab D - Facilitator Recruitment Materials OMB 0915-0212.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
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:
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
100
0
0
0
0
100
Annual IC Time Burden (Hours)
133
0
0
0
0
133
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Fast Track Memo
03152023 - CBO Tab A - Fast Track Memo - OMB 0915-0212.docx
03/22/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.