Trainee Ambassador Group Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 Trainee Ambassador Group Survey Form and Instruction
1 Trainee Ambassador Group Survey Draft of Survey Questions.docx Form and Instruction
1 Trainee Ambassador Group Survey Draft of Survey Questions.docx Form and Instruction
Generic Justification for MCHB Trainee Ambassador Survey.docx Trainee Ambassador Group Survey IC Document
Generic Justification for MCHB Trainee Ambassador Survey.docx Trainee Ambassador Group Survey IC Document

Information Collection (IC) Details

IC Title:	Trainee Ambassador Group 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	Trainee Ambassador Group Survey	Draft of Survey 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)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Trainee Ambassador Group Survey	Generic Justification for MCHB Trainee Ambassador Survey.docx	10/13/2023

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