Customer Satisfaction with the 2012 Guide to Clinical Preventive Services

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Document Name Document Type
Form Form #1 Customer Satisfaction with the 2012 Guide to Clinical Preventive Services Form
Form #1 Guide to Clinical Preventive Services Feedback Questionn Attachment A -- Guide to Clinical Preventive Services Feedback Questionnaire BC.docx Form
OMB Submission Form -- Customer Satisfaction with the 2012 Guide to Clinical Preventive Services.docx OMB Submission Form -- Customer Satisfaction with the 2012 Guide to Clinical Preventive Services IC Document

Information Collection (IC) Details

IC Title:	Customer Satisfaction with the 2012 Guide to Clinical Preventive Services	Agency IC Tracking Number:

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
Form	Form #1	Guide to Clinical Preventive Services Feedback Questionnaire	Attachment A -- Guide to Clinical Preventive Services Feedback Questionnaire BC.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	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	5,000	0	0	0	0	0
Annual IC Time Burden (Hours)	167	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Submission Form -- Customer Satisfaction with the 2012 Guide to Clinical Preventive Services	OMB Submission Form -- Customer Satisfaction with the 2012 Guide to Clinical Preventive Services.docx	08/02/2012

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