Information Collection

Survey - Advocate

IC 249202 under ICR 202409-0925-003 · OMB 0925-0774.

Documents and Forms

Document Name Document Type
Form 1 Survey - Advocate Form
1 Survey Attachment 2 Advocate Survey 4.29.24.docx Form
1 Survey Attachment 2 Advocate Survey 4.29.24.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey - Advocate	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	Survey	Attachment 2 Advocate Survey 4.29.24.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0156, âRecords of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/ODâ	FR Citation: 67 FR 60742

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6	-9	15
Annual IC Time Burden (Hours)	1	0	1
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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