Information Collection

The Nationwide Provider Network Customer Satisfaction Survey

IC 209938 under ICR 201211-0920-003 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material.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
LHI Survey 12.12.13.docx Other-WORD
LHI Customer Service Fast Track Application.docx LHI Customer Service Fast Track Application IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	The Nationwide Provider Network 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
Other-WORD			LHI Survey 12.12.13.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program Records, and WTC Health Program Records HHS/CDC/NIOSH	FR Citation: 76 FR 31212

Number of Respondents: 2,100	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	6,300	0	0	0	0	0
Annual IC Time Burden (Hours)	420	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
LHI Customer Service Fast Track Application	LHI Customer Service Fast Track Application.docx	12/19/2013

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