Information Collection

Health Center Program Support Customer Service Survey

IC 264347 under ICR 202503-0906-002 · OMB 0906-0084.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Health Center Program Support Customer Service Survey	Form and Instruction
Form 1 EHBs Customer Support Center Survey Screenshot Health Center Program Support Customer Service Survey	Form and Instruction
1 EHBs Customer Support Center Survey Screenshot EHBs Customer Support Center Survey Screenshot.docx	Form and Instruction
1 EHBs 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 IC Request	IC Document
HRSA EHBs Survey Supporting Statement draft 020221.docx Original Generic IC 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: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	800	800
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 IC Request		01/09/2024

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].