Information Collection

Customer Satisfaction Assessment of CDC TB Lab Site Visits

IC 225689 under ICR 201407-0920-003 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer Satisfaction Assessment of CDC TB Lab Site Visits	Form
TB Lab Site Visit Assessment Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation Immediate Follow-up.docx	Form
TB Labs Site Visit Assessment Appendix 1_Survey Questions_Site Visit Evaluation_immediate follow-up.docx	Form
Template-Customer Satisfaction Site Visit_Online.docx Request for Approval	IC Document

IC Title:

Customer Satisfaction Assessment of CDC TB Lab Site Visits

Agency IC Tracking Number:

17SI

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	TB Lab Site Visit Assessment	Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation Immediate Follow-up.docx		Yes	Yes	Fillable Fileable
Form	none	TB Labs Site Visit Assessment	Appendix 1_Survey Questions_Site Visit Evaluation_immediate follow-up.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 58

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	58	58
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Template-Customer Satisfaction Site Visit_Online.docx	02/13/2017

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