Office of Medical Services Medical Clearance Process Customer Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Office of Medical Services Medical Clearance Process Customer Satisfaction Survey	Agency IC Tracking Number:

IC Status: Unchanged

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	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 %

	Requested	Previously Approved
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

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.