Patient Satisfaction Survey, at CRHC

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Document Name Document Type
Form 0917-0036-32 Patient Satisfaction Survey, at CRHC Form and Instruction
0917-0036-32 Patient Satisfaction Survey, at Cheyenne River Health Ce OMB No. 0917- 0036-32, Patient Satisfaction Survey.docx Form and Instruction
OMB No. 0917-0036-32, Mini-Supporting Statement.docx OMB No. 0917-0036-32, Mini-Supporting Statement for Patient Satisfaction Survey, at CRHC IC Document

Information Collection (IC) Details

IC Title:	Patient Satisfaction Survey, at CRHC	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	0917-0036-32	Patient Satisfaction Survey, at Cheyenne River Health Center	OMB No. 0917- 0036-32, Patient Satisfaction Survey.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 540	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	540	540
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No. 0917-0036-32, Mini-Supporting Statement for Patient Satisfaction Survey, at CRHC	OMB No. 0917-0036-32, Mini-Supporting Statement.docx	01/06/2014

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