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Customer Feedback Survey of 2015 EIS Conference
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0920-0919
IC ID: 215171
OMB.report
HHS/CDC
OMB 0920-0919
ICR 201410-0920-001
IC 215171
( )
Documents and Forms
Document Name
Document Type
Customer Feedback Survey of 2015 EIS Conference
Form
2015 EIS Conference Survey
Att_2_Customer_Service_Feedback_Survey_Screenshots.docx
Form
2015 EIS Conference Survey
Att_1_2015 EIS Conf Customer_Service_Survey.docx
Form
Post Conference Flyer02212015_blank.pdf
Survey Flyer
IC Document
GenIC_Request_2015_EIS_Conf_20150212.docx
Request for Approval
IC Document
2015 EIS Conf Cust Survey_New Requirements_Final.docx
Request Summary
IC Document
Att_4_Invitation Email.docx
Invitation email
IC Document
Att_5_Reminder_Email.docx
Reminder email
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Customer Feedback Survey of 2015 EIS Conference
Agency IC Tracking Number:
15PH
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
none
2015 EIS Conference Survey
Att_2_Customer_Service_Feedback_Survey_Screenshots.docx
Yes
Yes
Fillable Fileable
Form
none
2015 EIS Conference Survey
Att_1_2015 EIS Conf Customer_Service_Survey.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,000
0
2,000
0
0
0
Annual IC Time Burden (Hours)
333
0
333
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Survey Flyer
Post Conference Flyer02212015_blank.pdf
02/23/2015
Request for Approval
GenIC_Request_2015_EIS_Conf_20150212.docx
02/23/2015
Request Summary
2015 EIS Conf Cust Survey_New Requirements_Final.docx
02/23/2015
Invitation email
Att_4_Invitation Email.docx
02/23/2015
Reminder email
Att_5_Reminder_Email.docx
02/23/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.