Information Collection

Voluntary Customer Satisfaction Survey of AHRQ WebM&M Users

IC 211461 under ICR 201104-0935-006 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Voluntary Customer Satisfaction Survey of AHRQ WebM&M Users	Form and Instruction
1 AHRQ WebM&M Customer Satisfaction Survey 2014-CSS-AHRQ WebMM Users.docx	Form and Instruction
Submission Form-2014-WebM&M.docx Voluntary Customer Satisfaction Survey of AHRQ WebM&M Users	IC Document

IC Title:

Voluntary Customer Satisfaction Survey of AHRQ WebM&M Users

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	AHRQ WebM&M Customer Satisfaction Survey	2014-CSS-AHRQ WebMM Users.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: AHRQ WebM&M Customer Satisfaction Survey

FR Citation: 76 FR 21746

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

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	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Voluntary Customer Satisfaction Survey of AHRQ WebM&M Users	Submission Form-2014-WebM&M.docx	04/29/2014

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