The World Trade Center Health Program for Responders at Rutgers University Customer Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0953 The World Trade Center Health Program for Responders at Rutgers University Customer Satisfaction Survey Form and Instruction
0920-0953 Patient Satisfaction Survey-Rutgers 12.10.13 Patient Satisfaction Survey-Rutgers 12.10.13.doc Form and Instruction
Rutgers Customer Service Fast Track.docx Rutgers Customer Service Fast Track IC Document

Information Collection (IC) Details

IC Title:	The World Trade Center Health Program for Responders at Rutgers University 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	0920-0953	Patient Satisfaction Survey-Rutgers 12.10.13	Patient Satisfaction Survey-Rutgers 12.10.13.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	600	0	0	0	0	0
Annual IC Time Burden (Hours)	50	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Rutgers Customer Service Fast Track	Rutgers Customer Service Fast Track.docx	12/11/2013

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