Information Collection

It's a Noisy Planet. Protect Their Hearing. Campaign: Customer Satisfaction Survey

IC 206397 under ICR 201112-0925-001 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 It's a Noisy Planet. Protect Their Hearing. Campaign: Customer Satisfaction Survey	Form and Instruction
1 Customer Satisfaction Survey Customer_Satisfaction_Survey_Screenshots.pdf	Form and Instruction
2 Parent Survey Parent_Survey_Screenshots.pdf	Form and Instruction
Customer_Satisfaction_Survey_Text_file.rtf Customer_Satisfaction_Survey_Text_file	IC Document
Parent_Survey_Text_file.rtf Parent_Survey_Text_file	IC Document
Customer_Satisfaction_Email_Invite.docx Customer_Satisfaction_Email_Invite	IC Document
Parent_Survey_Invite.docx Parent_Survey_Invite	IC Document
NoisyPlanet_FastTrackForm 2013 4.8.2013.doc Fast Track Form	IC Document

IC Title:

It's a Noisy Planet. Protect Their Hearing. Campaign: 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	Customer Satisfaction Survey	Customer_Satisfaction_Survey_Screenshots.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Parent Survey	Parent_Survey_Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 550

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	550	0	0	0	0	0
Annual IC Time Burden (Hours)	105	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Customer_Satisfaction_Survey_Text_file	Customer_Satisfaction_Survey_Text_file.rtf	03/25/2013
Parent_Survey_Text_file	Parent_Survey_Text_file.rtf	03/25/2013
Customer_Satisfaction_Email_Invite	Customer_Satisfaction_Email_Invite.docx	03/25/2013
Parent_Survey_Invite	Parent_Survey_Invite.docx	03/25/2013
Fast Track Form	NoisyPlanet_FastTrackForm 2013 4.8.2013.doc	04/08/2013

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