Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

Documents and Forms

Document Name Document Type
Form 1 Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction
Form 1 Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction
1 Comprehensive Survey 2024-09-12_SATA_Comprehensive-Survey-and-Consent_Final.docx Form and Instruction
1 Comprehensive Survey 2024-09-12_SATA_Comprehensive-Survey-and-Consent_Final.docx Form and Instruction
2 Post-TA Activity Survey 2024-09-12_SATA_Post-TA-Activity-Survey-and-Consent_Final.docx Form and Instruction
2 Post-TA Activity Survey 2024-09-12_SATA_Post-TA-Activity-Survey-and-Consent_Final.docx Form and Instruction
3 Qualitative Interview 2024-09-12_SATA_Qual-Interview-Guide-and-Consent_Final.docx Form and Instruction
3 Qualitative Interview 2024-09-12_SATA_Qual-Interview-Guide-and-Consent_Final.docx Form and Instruction
2024-09-12_SATA_OMB-Fast-Track-Memo.docx Generic IC Memo_SATA Evaluation IC Document
2024-09-12_SATA_OMB-Fast-Track-Memo.docx Generic IC Memo_SATA Evaluation IC Document

Information Collection (IC) Details

IC Title:	Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Comprehensive Survey	2024-09-12_SATA_Comprehensive-Survey-and-Consent_Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Post-TA Activity Survey	2024-09-12_SATA_Post-TA-Activity-Survey-and-Consent_Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Qualitative Interview	2024-09-12_SATA_Qual-Interview-Guide-and-Consent_Final.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 582	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	582	582
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic IC Memo_SATA Evaluation	2024-09-12_SATA_OMB-Fast-Track-Memo.docx	09/12/2024

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