Public Burden Statement:  The purpose of this collection is for quality assurance only. The information gathered will only be used for identifying customer service quality for improvements. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0915-0212 and it is valid until XX/XX/202X. This information collection is voluntary. The response is entirely discretionary and has no direct effect on any benefit or privilege for the respondent. Public reporting burden for this collection of information is estimated to average .008 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov.  

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