Listening Session Questions

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Listening Session Questions Form and Instruction
Form 1 Listening Session Questions Form and Instruction
1 Listening Session Questions Listening Session Questions.docx Form and Instruction
1 Listening Session Questions Listening Session Questions.docx Form and Instruction
Fast track memo_Listening Sessions.docx MCHB Listening Session Fast Track Memo IC Document
Fast track memo_Listening Sessions.docx MCHB Listening Session Fast Track Memo IC Document

Information Collection (IC) Details

IC Title:	Listening Session Questions	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	Listening Session Questions	Listening Session Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
MCHB Listening Session Fast Track Memo	Fast track memo_Listening Sessions.docx	05/01/2023

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