View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Rural Health Care Program	Agency IC Tracking Number:	WCB

IC Status: New

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
Other-Survey			RHC_Survey_v4 rk.docx		Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,535	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

	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	5,535	0	5,535	0	0	0
Annual IC Time Burden (Hours)	2,890	0	2,890	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
General Clearance Submission Template Small Group Discussion	Generic Clearance Submission Template Small Discussion Group Feedback (final).docx	11/20/2015
General Clearance Submission Template RHC Survey	Generic Clearance Submission Template RHC customer satisfication survey (final).docx	11/20/2015
General Clearance Submission Template RHC Usability Testing	Generic Clearance Submission Template RHC usability testing (final).docx	11/20/2015

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