OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Professional Impact Survey

IC 267354 under ICR 202508-0906-004 · OMB unassigned.

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

View Information Collection (IC)

Health Professional Impact Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Health Professional Impact Survey Attachment B1 - HP Impact Survey_Final.docx Yes Yes Fillable Fileable
Form and Instruction 1 Health Professional Impact Survey (Michigan Grantee Only) MI PMHCA HPI Survey_Tracked 8-19-25.docx Yes Yes Fillable Fileable

Health Health Care Services

 

21,070 21,070
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved 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 42,140 0 0 0 0 42,140
Annual IC Time Burden (Hours) 7,164 0 0 0 0 7,164
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment B4 - HP Impact Survey Consent_Final Attachment B4 - HP Impact Survey Consent_Final.docx 04/30/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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