Information Collection

Self-Administered Customer Satisfaction Surveys of Meetings and Conference Sessions

IC 198674 under ICR 201102-0925-009 · OMB 0925-0585.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Self-Administered Customer Satisfaction Surveys of Meetings and Conference Sessions	Form and Instruction
1 Survey CSS Appendix 1 Participant Questionnaire 11-0503.doc	Form and Instruction
CSS GenericClearanceForm 11-0503.doc CSS GenericClearanceForm 11-0503	IC Document
Mini Supporting Statement 0925-0585-06-1.docx Mini Supporting Statement 0925-0585-06-1	IC Document
CSS Appendix 2 IRB Approval.pdf CSS Appendix 2 IRB Approval	IC Document

IC Title:

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	1	Survey	CSS Appendix 1 Participant Questionnaire 11-0503.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,265

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 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	4,530	0	0	0	0	0
Annual IC Time Burden (Hours)	483	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
CSS GenericClearanceForm 11-0503	CSS GenericClearanceForm 11-0503.doc	07/28/2011
Mini Supporting Statement 0925-0585-06-1	Mini Supporting Statement 0925-0585-06-1.docx	07/28/2011
CSS Appendix 2 IRB Approval	CSS Appendix 2 IRB Approval.pdf	07/28/2011

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