Information Collection

Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guide

IC 270267 under ICR 202408-0970-005 · OMB 0970-0531.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0531 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
QUEST_RHP SRHC Interview.docx	Other-Interview
QUEST_RHP Client Questionnaire.docx	Other-Questionnaire
QUEST_RHP Local Provider Guide.docx	Other-Focus Group Protocol
SSA_RSS Set Asides Assessment_Formative Prog Support_RHP_8.20.2024_updated.docx SSA - Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guides	IC Document
Letter_RHP Client Invitation and Consent_ENGLISH.docx Consent Form - RSS RHP Set-Aside Programs Assessment Guide	IC Document

IC Title:

Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guide

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview	QUEST_RHP SRHC Interview.docx	Yes	Yes	Printable Only
Other-Questionnaire	QUEST_RHP Client Questionnaire.docx	Yes	Yes	Printable Only
Other-Focus Group Protocol	QUEST_RHP Local Provider Guide.docx	Yes	Yes	Printable Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 85

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	85	85
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA - Refugee Support Services Refugee Health Promotion Set-Aside Programs Assessment Guides	SSA_RSS Set Asides Assessment_Formative Prog Support_RHP_8.20.2024_updated.docx	08/20/2024
Consent Form - RSS RHP Set-Aside Programs Assessment Guide	Letter_RHP Client Invitation and Consent_ENGLISH.docx	08/20/2024

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