OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

HRSA Web Survey

IC 266005 under ICR 202503-0906-002 · OMB 0906-0084.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
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Information Collection (IC) Details

View Information Collection (IC)

HRSA Web Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 HRSA Web Survey HRSA Website Survey (Clean Copy).docx Yes Yes Fillable Fileable
Form 2 HRSA Web Survey (Spanish Language) hrsa-approved-survey-questions-final_ES (clean copy).docx Yes Yes Fillable Fileable

Health Health Care Services

 

16,667 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 16,667 0 0 0 0 16,667
Annual IC Time Burden (Hours) 833 0 0 0 0 833
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
HRSA Web Survey Redline HRSA Website Survey (Revised Tracked Changes).docx 03/26/2024
Fast Track Request fast-track-hrsa-web-survey-20240304 .docx 03/26/2024
Revised Spanish Language Survey (Track Changes) hrsa-approved-survey-questions-final_ES (in track changes).docx 03/26/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.