Information Collection

Patient Satisfaction Survey, Michael E. DeBakey Home Care Program

IC 194516 under ICR 201009-2900-003 · OMB 2900-0775.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0775 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DeBakey Survey Instrument 2010(v3).pdf Telephonic Survey Method	Other-Telephonic

IC Title:

Patient Satisfaction Survey, Michael E. DeBakey Home Care Program

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-Telephonic			DeBakey Survey Instrument 2010(v3).pdf	Telephonic Survey Method	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	100	100
Annual IC Time Burden (Hours)	17	17
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.