View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Health Center Workforce Well-Being Survey: Listening Sessions	Agency IC Tracking Number:

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
Form	1	Listening Session Consent Form revised July 6.docx	Listening Session Consent Form revised July 6.docx		Yes	Yes	Fillable Fileable
Other-SLIDE DECK			Leadership Listening Session Deck revised 3-23-2020 approved July 6.pptx		Yes	No	Printable Only

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: 60	Number of Respondents for Small Entity: 60

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 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	60	0	60	0	0	0
Annual IC Time Burden (Hours)	120	0	120	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Listening Session Supporting Statement A_	Listening Session Supporting Statement A_081020_CLEAN2.docx	08/18/2020
Listening Session Supporting Statement B_with revisions July 6	Listening Session Supporting Statement B_with revisions July 6.docx	08/18/2020

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