HRSA Electronic Handbooks Customer Service Survey

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

Documents and Forms

Document Name Document Type
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction
1 EHB Customer Support Center Survey Screenshot EHBs Customer Support Center Survey Screenshot.docx Form and Instruction
1 EHB Customer Support Center Survey Screenshot EHBs Customer Support Center Survey Screenshot.docx Form and Instruction
HRSA EHBs Survey Supporting Statement draft 020221.docx Original Generic Request IC Document
HRSA EHBs Survey Supporting Statement draft 020221.docx Original Generic Request IC Document

Information Collection (IC) Details

IC Title:	HRSA Electronic Handbooks Customer Service Survey	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
Form and Instruction	1	EHB Customer Support Center Survey Screenshot	EHBs Customer Support Center Survey Screenshot.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Original Generic Request	HRSA EHBs Survey Supporting Statement draft 020221.docx	01/09/2024

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