Patient Satisfaction Survey, Alburquerque Service Unit

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⚠️ Notice: This information collection may be referencing outdated material.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 0917-0036-36 Patient Satisfaction Survey, Alburquerque Service Unit Form and Instruction
0917-0036-36 OMB No. 0917-0036-36, Patient Satisfaction Survey, Albuq OMB 0917-0036-36, Patient Satisfaction Survey ABQ SU.doc Form and Instruction
OMB 0917-0036-36, Mini-Supporting Statement, Patient Satisfaction Survey, ABQ SU.doc OMB No. 0917-0036-36, Mini-Supporting Statement for Patient Satisfaction Survey, ABQ SU IC Document

Information Collection (IC) Details

IC Title:	Patient Satisfaction Survey, Alburquerque Service Unit	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	0917-0036-36	OMB No. 0917-0036-36, Patient Satisfaction Survey, Albuquerque Service Unit	OMB 0917-0036-36, Patient Satisfaction Survey ABQ SU.doc		No	No	Printable Only

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: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No. 0917-0036-36, Mini-Supporting Statement for Patient Satisfaction Survey, ABQ SU	OMB 0917-0036-36, Mini-Supporting Statement, Patient Satisfaction Survey, ABQ SU.doc	02/24/2014

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