Information Collection

Eisenberg Center Voluntary Customer Survey Generic Clearance for the Agency for Healthcare Research and Quality

IC 46390 under ICR 200612-0935-001 · OMB unassigned.

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IC Title:

Eisenberg Center Voluntary Customer Survey Generic Clearance for the Agency for Healthcare Research and Quality

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.5

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: 1,740

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,740	1,740
Annual IC Time Burden (Hours)	1,186	1,186
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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