Information Collection

Office of Medical Services Medical Clearance Process Customer Satisfaction Survey

IC 213943 under ICR 201407-0420-005 · OMB 0420-0545.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0420-0545 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PC-2142 Office of Medical Services Medical Clearance Process Customer Satisfaction Survey	Form
Survey link message-Final.docx	Instruction
PC-2142 OHS Medical Clearance Process Customer Survey Customer satisfaction survey.pdf	Form
OHS Customer Survey Generic Clearance Submission-Final.docx OHS Customer Survey Generic Clearance Submission	IC Document

IC Title:

Office of Medical Services Medical Clearance Process Customer Satisfaction Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PC-2142	OHS Medical Clearance Process Customer Survey	Customer satisfaction survey.pdf		Yes	Yes	Fillable Fileable
Instruction			Survey link message-Final.docx		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OHS Customer Survey Generic Clearance Submission	OHS Customer Survey Generic Clearance Submission-Final.docx	11/18/2014

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