Information Collection

Customer Satisfaction On-line Survey for Applicants: Officials of Host Institutions

IC 204297 under ICR 201209-0925-003 · OMB 0925-0665.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0665 can be found here:

2013-08-20 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment A3.4 Screenshots for Customer Satisfaction On-line Host Survey Customer Satisfaction On-line Survey for Applicants: Officials of Host Institutions	Form and Instruction
Attachment A3.4 Screenshots for Customer Satisfaction On-line Host Surve Attachment A.3.4 - Screenshots Customer Satisfaction Online Survey for Applicants (Host Institutions).pdf	Form and Instruction
Attachment A.3.2 - Customer Satisfaction Online Survey for Applicants (Host Institutions).doc Attachment A3.2 Customer Satisfaction Host Survey (Paper Version)	IC Document
Attachment B.1.2 - Protocols Customer Satisfaction Survey Host Institutions.doc On-line Survey Protocols	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Customer Satisfaction On-line Survey for Applicants: Officials of Host Institutions

Agency IC Tracking Number:

Is this a Common Form? No

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	Attachment A3.4	Screenshots for Customer Satisfaction On-line Host Survey	Attachment A.3.4 - Screenshots Customer Satisfaction Online Survey for Applicants (Host Institutions).pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-25-0156 Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD

FR Citation: 67 FR 60742

Number of Respondents: 150

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 Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A3.2 Customer Satisfaction Host Survey (Paper Version)	Attachment A.3.2 - Customer Satisfaction Online Survey for Applicants (Host Institutions).doc	09/17/2012
On-line Survey Protocols	Attachment B.1.2 - Protocols Customer Satisfaction Survey Host Institutions.doc	09/26/2012

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