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Primary Health Care Digest Newsletter Subscriber Survey
Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration
OMB: 0915-0212
IC ID: 259876
OMB.report
HHS/HSA
OMB 0915-0212
ICR 202401-0915-001
IC 259876
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:
2024-01-10 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Primary Health Care Digest Newsletter Subscriber Survey
Form and Instruction
Form 1
Primary Health Care Digest Newsletter Subscriber Survey
Form and Instruction
1 Primary Health Care Digest Newsletter Subscriber Survey
03.31.2023-FINAL-CLEAN.docx
Form and Instruction
1 Primary Health Care Digest Newsletter Subscriber Survey
03.31.2023-FINAL-CLEAN.docx
Form and Instruction
Fast Track Memo - BPHC Digest Newsletter revised 4.27.23 .docx
PHC Digest Newsletter Subscriber Survey
IC Document
Fast Track Memo - BPHC Digest Newsletter revised 4.27.23 .docx
PHC Digest Newsletter Subscriber Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Primary Health Care Digest Newsletter Subscriber Survey
Agency IC Tracking Number:
IC Status:
Unchanged
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
1
Primary Health Care Digest Newsletter Subscriber Survey
03.31.2023-FINAL-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:
5,000
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
5,000
0
0
0
0
5,000
Annual IC Time Burden (Hours)
583
0
0
0
0
583
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
PHC Digest Newsletter Subscriber Survey
Fast Track Memo - BPHC Digest Newsletter revised 4.27.23 .docx
04/27/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.