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Patient Satisfaction Survey, Tohatchi
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0917-0036
IC ID: 211447
OMB.report
HHS/IHS
OMB 0917-0036
ICR 201301-0917-001
IC 211447
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:
2022-01-13 - Extension without change of a currently approved collection
2018-07-12 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0917-0036
Patient Satisfaction Survey, Tohatchi
Form and Instruction
0917-0036 OMB No. 0917-0036-39, Patient Satisfaction Survey, Tohat
THC Pharmacy Patient Satisfaction Survey1.docx
Form and Instruction
OMB 0917-0036-39, Mini-Supporting Statement for Patient Satisfaction Survey, Tohatchi 4-28-14.doc
OMB No. 0917-0036-39, Mini-Supporting Statement for Patient Satisfaction Survey, Tohatchi
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Patient Satisfaction Survey, Tohatchi
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
OMB No. 0917-0036-39, Patient Satisfaction Survey, Tohatchi
THC Pharmacy Patient Satisfaction Survey1.docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
360
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
360
0
360
0
0
0
Annual IC Time Burden (Hours)
30
0
30
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB No. 0917-0036-39, Mini-Supporting Statement for Patient Satisfaction Survey, Tohatchi
OMB 0917-0036-39, Mini-Supporting Statement for Patient Satisfaction Survey, Tohatchi 4-28-14.doc
04/28/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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