Information Collection

Opportunities for Extramural Collaborations at the NIH Clinical Center (U01) Customer Satisfaction Survey

IC 212869 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⚠️ Notice: This information collection may be referencing outdated material.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 Opportunities for Extramural Collaborations at the NIH Clinical Center (U01) Customer Satisfaction Survey	Form and Instruction
1 Online customer satisfaction survey screen shots 0925-0643_CC Customer Satisfaction Survey Screenshots_8-13-14.docx	Form and Instruction
0925-0643_CC Customer Satisfaction Survey_Generic Template (2).doc Fast-Track Template	IC Document

IC Title:

Opportunities for Extramural Collaborations at the NIH Clinical Center (U01) 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	Online customer satisfaction survey screen shots	0925-0643_CC Customer Satisfaction Survey Screenshots_8-13-14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast-Track Template	0925-0643_CC Customer Satisfaction Survey_Generic Template (2).doc	08/28/2014

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