Information Collection

Bereaved Family Member Satisfaction Survey

IC 178992 under ICR 200703-2900-007 · OMB 2900-0701.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0701 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FATE-lite SURVEY Bereaved Fam Sat 2-7-07.doc	Other-survey

IC Title:

Bereaved Family Member Satisfaction Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-survey					No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800

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	1,800	1,800
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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