Information Collection

HRSA Electronic Handbooks Customer Service Survey

IC 264346 under ICR 202503-0906-002 · OMB 0906-0084.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HRSA Electronic Handbooks Customer Service Survey	Form and Instruction
Form 1 EHB Customer Support Center Survey Screenshot 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

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1				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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Original Generic Request		01/09/2024

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

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