Information Collection

Data Sharing for Demographic Research (DSDR) Customer Satisfaction Survey

IC 211191 under ICR 201110-0925-003 · OMB 0925-0643.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Data Sharing for Demographic Research (DSDR) Customer Satisfaction Survey	Form and Instruction
1 DSDR Screenshots DSDR Customer Satisfaction Survey - Screenshots_0925-0643.docx	Form and Instruction
Generic_Template_DSDR_NICHD_0925-0643.doc Generic Template DSDR	IC Document

IC Title:

Data Sharing for Demographic Research (DSDR) Customer Satisfaction Survey

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	DSDR Screenshots	DSDR Customer Satisfaction Survey - Screenshots_0925-0643.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,000	12,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Template DSDR	Generic_Template_DSDR_NICHD_0925-0643.doc	04/09/2014

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