Staff survey

Pregnancy Assistance Fund (PAF) Implementation Study

Documents and Forms

Document Name Document Type
0990_New_ PAF Staff Survey_Final to OMB.docx Other-survey
0990-New_PAF_Attachment E_Question by Question Source Table.docx Question by Question source Table for The staff Survey IC Document

Information Collection (IC) Details

IC Title:	Staff survey	Agency IC Tracking Number:

Is this a Common Form? No		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
Other-survey			0990_New_ PAF Staff Survey_Final to OMB.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	35	35
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Question by Question source Table for The staff Survey	0990-New_PAF_Attachment E_Question by Question Source Table.docx	02/24/2015

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