View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	NEHEP Partnership Summit Surveys (NEI)	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	Pre-Summit Survey	NEI_NEHEP_PreSummit_FinalSurvey_2023.02.09_CLEAN.docx		Yes	Yes	Fillable Fileable
Form	2	Post-Summit Survey instrument	NEI_NEHEP_PostSummit_FinalSurvey_2023.02.08_CLEAN.docx		Yes	Yes	Fillable Fileable

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: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

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	200	0	200	0	0	0
Annual IC Time Burden (Hours)	33	0	33	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
fast track for NEHEP Pre-Post Summit surveys	OMB Fast Track Form_NEHEP Partnership Summit 2023 Surveys_2023.01.20 (4).docx	02/10/2023
outreach emails	NEI_NEHEP Partnership Summit Survey_OutreachEmails_2023.02.08.docx	02/16/2023

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