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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
DeBakey Survey Instrument 2010(v3).pdf Telephonic Survey Method Other-Telephonic

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.