Health Center Workforce Well-being Survey

Health Center Workforce Survey Evaluation and Technical Assistance

Documents and Forms

Document Name Document Type
Form 2 Health Center Workforce Well-being Survey Form and Instruction
2 HRSA's Health Center's Well-being Survey Workforce Well-Being Survey.xlsx Form and Instruction
2 HRSA's Health Center's Well-being Survey Workforce Well-Being Survey.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Health Center Workforce Well-being Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	2	HRSA's Health Center's Well-being Survey	Workforce Well-Being Survey.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,400	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,400	1,400
Annual IC Time Burden (Hours)	467	467
Annual IC Cost Burden (Dollars)	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.