DIR Objective Review Assessment Survey

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

OMB: 0906-0084

IC ID: 265672

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
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 02262024 DIR Review Assessment Survey form 1 - screenshot Reviewer instr.pdf Yes Yes Fillable Fileable
Form and Instruction 1 Questions 1-5 02262024 FORM CHAIR Q 1-5.pdf Yes Yes Fillable Printable
Form and Instruction 2 Reviewer Evaluation Form 02262024 FORM Reviewer Evaluation Q 1- 15.pdf Yes Yes Fillable Fileable
Form and Instruction 3 Reviewer Evaluation Field Review 02262024 FORM Reviewer Evaluation-Field Review Q 1 - 12.pdf Yes Yes Fillable Fileable
Form and Instruction 1A Chair Reviewer Evaluation Q1-2 Chair Reviewer Evaluation Review Q1-2.PNG Yes Yes Fillable Fileable
Form and Instruction 1B Chair Reviewer Evaluation Review Form Q3-4 Chair Reviewer Evaluation Review Q3-4.PNG Yes Yes Fillable Fileable
Form and Instruction 1C Chair Reviewer Evaluation Review Q5 Chair Reviewer Evaluation Review Q5.PNG Yes Yes Fillable Fileable
Form and Instruction 2A Reviewer Evaluation- Field Review Q1-2 Reviewer Evaluation-Field Review Q1-2.PNG Yes Yes Fillable Fileable
Form and Instruction 2B Reviewer Evaluation- Field Review Q3-4 Reviewer Evaluation-Field Review Q3-4.PNG Yes Yes Fillable Fileable
Form and Instruction 2C Reviewer Evaluation- Field Review Q5-6 Reviewer Evaluation-Field Review Q5-6.PNG Yes Yes Fillable Fileable
Form and Instruction 2D Reviewer Evaluation- Field Review Q7-8 Reviewer Evaluation-Q7-8.PNG Yes Yes Fillable Fileable
Form and Instruction 2E Reviewer Evaluation- Field Review Q9-10 Reviewer Evaluation-Field Review Q9-10.PNG Yes Yes Fillable Fileable
Form and Instruction 2F Reviewer Evaluation- Field Review Q11-12 Reviewer Evaluation-Field Review Q11-12.PNG Yes Yes Fillable Fileable
Form and Instruction 3A Reviewer Evaluation Q1-2 Reviewer Evaluation-Q1-2.PNG Yes Yes Fillable Fileable
Form and Instruction 3B Reviewer Evaluation- Field Review Q3-4 Reviewer Evaluation-Q3-4.PNG Yes Yes Fillable Fileable
Form and Instruction 3C Reviewer Evaluation- Field Review Q5-6 Reviewer Evaluation-Q5-6.PNG Yes Yes Fillable Fileable
Form and Instruction 3E Reviewer Evaluation Q9-10 Reviewer Evaluation-Q9-10.PNG Yes Yes Fillable Fileable
Form and Instruction 3D Reviewer Evaluation- Field Review Q7-8 Reviewer Evaluation-Field Review Q7-8.PNG Yes Yes Fillable Fileable
Form and Instruction 3F Reviewer Evaluation- Field Review Q11-12 Reviewer Evaluation-Q11-12.PNG Yes Yes Fillable Fileable
Form and Instruction 3G Reviewer Evaluation- Field Review Q13-14 Reviewer Evaluation-Q13-14.PNG Yes Yes Fillable Fileable
Form and Instruction 3H Reviewer Evaluation- Field Review Q15 Reviewer Evaluation-Q15.PNG Yes Yes Fillable Fileable

Health Public Health Monitoring

 

900 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 900 0 0 0 0 900
Annual IC Time Burden (Hours) 450 0 0 0 0 450
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
DIR Objective Survey Review DIR Objective Review Assessment Survey New 3.4.24.docx 03/04/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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