NCTN Satisfaction Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 0925-0642 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NCTN Satisfaction Survey Form
1 NCTN Survey Screenshots NCTN Survey Screenshots - 11-16-16.docx Form
Fast Track NCTN.docx Fast track NCTN Customer Feedback IC Document
NCTN Survey Email Invite - 11-16-16.docx NCTN Survey Email Invite IC Document

Information Collection (IC) Details

IC Title:	NCTN 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	1	NCTN Survey Screenshots	NCTN Survey Screenshots - 11-16-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	92	92
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast track NCTN Customer Feedback	Fast Track NCTN.docx	11/16/2016
NCTN Survey Email Invite	NCTN Survey Email Invite - 11-16-16.docx	11/16/2016

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