View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Human Services Survey for Medical Personnel	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 and Instruction	NA	Areas of Worklife Survey and MBI Human Services Survey for Medical Personnel	Burnout Survey Questions.pdf	https://transform.mindgarden.com/assess/SAMPLE_new_self/272723f	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: NA	FR Citation: 85 FR 81551

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	300	0	300	0	0	0
Annual IC Time Burden (Hours)	75	0	75	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
DS-4183	ds4183 Wellness Working Group.pdf	11/15/2022

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