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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.