View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

HRSA Health Center Workforce Survey: Pilot Survey
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 2 HRSA Survey Draft HRSA Survey Draft V6.1.docx Yes Yes Fillable Fileable
Form 1 Informed Consent Pilot Survey Informed Consent_07192021_CLEAN.docx Yes Yes Fillable Fileable

Health Health Care Services

 

400 400
   
Private Sector Not-for-profit institutions
 
   100 %

  Requested 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 400 0 400 0 0 0
Annual IC Time Burden (Hours) 300 0 300 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A Pilot Survey Supporting Statement A 07192021_CLEAN.docx 06/29/2023
Supporting Statement B Pilot Survey Supporting Statement B 07192021_CLEAN.docx 06/29/2023
Pilot Survey Invitation Email from Health Center Pilot Survey Invitation Email from Health Center 07192021_CLEAN.docx 06/29/2023
Pilot Survey Invitation Email from JSI Pilot Survey Invitation Email from JSI 07192021.docx 06/29/2023
Pilot Survey Invite System Form Pilot Survey Invite System Form.docx 06/29/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.