Information Collection

Voluntary Customer Surveys To Implement E.o. 12862 Within The Health Care Finance Administration (hcfa)

IC 114116 under ICR 199404-0938-001 · OMB 0938-0652.

Documents and Forms

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Document Name	Document Type

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IC Title:

VOLUNTARY CUSTOMER SURVEYS TO IMPLEMENT E.O. 12862 WITHIN THE HEALTH CARE FINANCE ADMINISTRATION (HCFA)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 76,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	19,740	19,740
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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