Information Collection

The Modular Survey on Consumer Perceptions of Care - CSAT

IC 189574 under ICR 200710-0930-001 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Modular Survey The Modular Survey on Consumer Perceptions of Care - CSAT	Form and Instruction
Modular Survey Modular Survey Modular Survey OMB Attachment 1 - Modular Survey Instrument 6-15-09.doc	Form and Instruction
OMBTransLet5-2009.wpd Justification Memo	IC Document
Modular Survey OMB Update 6-15-09.doc Supporting Statement	IC Document

IC Title:

The Modular Survey on Consumer Perceptions of Care - CSAT

Agency IC Tracking Number:

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
Form and Instruction	Modular Survey	Modular Survey	Modular Survey OMB Attachment 1 - Modular Survey Instrument 6-15-09.doc		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,650

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	2,650	0	0	0	0	0
Annual IC Time Burden (Hours)	450	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification Memo	OMBTransLet5-2009.wpd	06/15/2009
Supporting Statement	Modular Survey OMB Update 6-15-09.doc	06/15/2009

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