Beneficiaries

OMHA Annual Appellant Climate Survey

OMB: 0990-0330

IC ID: 184626

Documents and Forms
Document Name
Document Type
Other-Introductory Letter English
Other-Introductory Letter English
Other-Introductory Letter Spanish
Other-Introductory Letter Spanish
Other-Telephone Introductory Script
Other-Telephone Introductory Script
Other-Telephone Survey Script Spanis
Other-Telephone Survey Script Spanis
Other-Reminder Voicemail Script Engl
Other-Reminder Voicemail Script Engl
Other-Reminder Voicemail Script Span
Other-Reminder Voicemail Script Span
Other-Reminder Letter English
Other-Reminder Letter English
Other-Reminder Letter Spanish
Other-Reminder Letter Spanish
Other-Confidentiality Agreement
Other-Confidentiality Agreement
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Beneficiaries
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Introductory Letter English Appendix C1. Introductory Letter (English).docx Yes Yes Paper Only
Other-Introductory Letter Spanish Appendix C2. Introductory Letter (Spanish).docx Yes Yes Paper Only
Other-Telephone Introductory Script English Appendix C3 Telephone Survey Introduction Script (English).docx No   Paper Only
Other-Telephone Survey Script Spanish Appendix C4 Telephone Survey Introduction Script (Spanish).docx No   Paper Only
Other-Reminder Voicemail Script English Appendix C5 Reminder Voicemail Script (English).docx No   Paper Only
Other-Reminder Voicemail Script Spanish Appendix C6 Reminder Voicemail Script (Spanish).docx No   Paper Only
Other-Reminder Letter English Appendix C7. Reminder Letter with Paper Questionnaire (English).docx No   Fillable Fileable
Other-Reminder Letter Spanish Appendix C8. Reminder Letter with Paper Questionnaire (Spanish).docx No   Fillable Fileable
Other-Confidentiality Agreement Appendix A1 Data Collector Confidentiality Agreement.docx Yes Yes Paper Only

General Government Executive Functions

 

400 0
   
Individuals or Households
 
   10 %

  Approved 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) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
60-day 60-dayFederal Register, Volume 82 Issue 187 (Thursday, September 28, 2017).htm 01/26/2018
30day 30-day Federal Register, Volume 82 Issue 247 (Wednesday, December 27, 2017).htm 01/26/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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