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Organdonor.gov Website Survey
Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration
OMB: 0915-0212
IC ID: 248953
OMB.report
HHS/HSA
OMB 0915-0212
ICR 202312-0915-001
IC 248953
( )
⚠️ Notice: This information collection may be referencing outdated material.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
2024-01-04 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Organdonor.gov Website Survey
Form and Instruction
1 HRSA DoT Organdonor.gov Website Survey Questionnaire.doc
FORM HRSA DoT Organdonor.gov Website Survey Questionnaire.docx
Form and Instruction
1 HRSA DoT Organdonor.gov Website Survey Questionnaire.doc
FORM HRSA DoT Organdonor.gov Website Survey Questionnaire.docx
Form and Instruction
SUPPORTING STATEMENT HRSA DoT Organdonor.gov Website CLEAN.docx
SUPPORTING STATEMENT HRSA DoT Organdonor.gov Website
IC Document
SUPPORTING STATEMENT HRSA DoT Organdonor.gov Website CLEAN.docx
SUPPORTING STATEMENT HRSA DoT Organdonor.gov Website
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Organdonor.gov Website 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
HRSA DoT Organdonor.gov Website Survey Questionnaire.docx
FORM HRSA DoT Organdonor.gov Website Survey Questionnaire.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:
400
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
400
0
0
0
0
400
Annual IC Time Burden (Hours)
67
0
0
0
0
67
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SUPPORTING STATEMENT HRSA DoT Organdonor.gov Website
SUPPORTING STATEMENT HRSA DoT Organdonor.gov Website CLEAN.docx
08/19/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.