Information Collection

Office of Minority Health's Customer Satisfaction Survey

IC 227295 under ICR 201407-0910-016 · OMB 0910-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0360 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OMH Survey Questions.docx	Other-Survey
0360 Justification Memo for OMB - OMH Survey.doc OMB Justification Memo	IC Document

IC Title:

Office of Minority Health's 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
Other-Survey			OMH Survey Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,300

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	1,300	1,300
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo	0360 Justification Memo for OMB - OMH Survey.doc	06/26/2017

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