OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

HRSA Web Survey

IC 264362 under ICR 202401-0915-004 · OMB 0915-0212.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

HRSA Web Survey
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 English Language Survey hrsa-approved-survey-questions-final_ENG.docx Yes Yes Fillable Fileable
Form 2 Spanish Language Survey hrsa-approved-survey-questions-final_ES.docx Yes Yes Fillable Fileable

Health Health Care Services

 

16,667 0
   
Individuals or Households
 
   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 16,667 0 16,667 0 0 0
Annual IC Time Burden (Hours) 833 0 833 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Original Generic IC Request fast-track-hrsa-web-survey-20230817 Final.docx 01/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.