Information Collection

Children's Hospital Collaboration Forum Customer Satisfaction Survey

IC 214764 under ICR 201407-0920-001 · OMB 0920-1026.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Children's Hospital Collaboration Forum Customer Satisfaction Survey	Form
Survey Attachment A_Children’s Hospital Collaboration Forum_ Survey.pdf	Form
Attachment B_Children’s Hospital Collaboration Forum_Invitation Email.docx Email Invitation	IC Document
Attachment C_Children’s Hospital Collaboration Forum_Reminder Email.docx Reminder Email	IC Document
GenIC 0920-1026_Children's Hospital Collaboration Forum.docx Request for Approval	IC Document

IC Title:

Agency IC Tracking Number:

15MF

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	none	Survey	Attachment A_Childrenâs Hospital Collaboration Forum_ Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	90	90
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Email Invitation	Attachment B_Childrenâs Hospital Collaboration Forum_Invitation Email.docx	01/26/2015
Reminder Email	Attachment C_Childrenâs Hospital Collaboration Forum_Reminder Email.docx	01/26/2015
Request for Approval	GenIC 0920-1026_Children's Hospital Collaboration Forum.docx	01/26/2015

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