Health Care Providers and Suppliers

OMHA Annual Appellant Climate Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0330 can be found here:

Documents and Forms

Document Name Document Type
0990-Appellant Survey FY10 (04 28 11) (2).pdf Other-Survey

Information Collection (IC) Details

IC Title:	Health Care Providers and Suppliers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Survey			0990-Appellant Survey FY10 (04 28 11) (2).pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	240	120	120
Annual IC Time Burden (Hours)	44	22	22
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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