Sub-Study #9 & #10 - HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (#9) and Federal Respondents (#10)

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⚠️ Notice: This information collection may be referencing outdated material.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 0925-0642 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Sub-Study #9 & #10 - HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (#9) and Federal Respondents (#10) Form and Instruction
1 HD Calc Survey Attach 2_Full Survey with identified skips_HD Calc.docx Form and Instruction
Attach 1_Survey Screenshots_HD Calc.pptx Attach 1_Survey Screenshots_HD Calc IC Document
Attach 3_Email Invite_HD Calc.doc Attach 3_Email Invite_HD Calc IC Document
_9 & _10_Fast-Track_Request_Fed_HD Calc[2].doc #9 & #10_Fast-Track_Request_Fed_HD Calc IC Document

Information Collection (IC) Details

IC Title:	Sub-Study #9 & #10 - HD*Calc Customer Satisfaction Survey for Different Category of Respondents: State (#9) and Federal Respondents (#10)	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 and Instruction	1	HD Calc Survey	Attach 2_Full Survey with identified skips_HD Calc.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	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	7	0	0	0	0	0
Annual IC Time Burden (Hours)	1	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attach 1_Survey Screenshots_HD Calc	Attach 1_Survey Screenshots_HD Calc.pptx	04/18/2012
Attach 3_Email Invite_HD Calc	Attach 3_Email Invite_HD Calc.doc	04/18/2012
#9 & #10_Fast-Track_Request_Fed_HD Calc	_9 & _10_Fast-Track_Request_Fed_HD Calc[2].doc	04/30/2012

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