Information Collection

KAI Annual Client Satisfaction Survey

IC 218063 under ICR 201501-0925-004 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 KAI Annual Client Satisfaction Survey	Form and Instruction
1 KAI Annual Client Survey Printscreens KAI Annual Client Survey Printscreens_updated 8-24-2015.docx	Form and Instruction
KAI Annual Client Survey Fast Track Form.doc KAI Annual Client Survey Fast Track Form	IC Document
Questions for NIAMS Customer Survey1_FINAL.docx Questions for NIAMS Customer Survey 1	IC Document

IC Title:

KAI Annual Client 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
Form and Instruction	1	KAI Annual Client Survey Printscreens	KAI Annual Client Survey Printscreens_updated 8-24-2015.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	30	30
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
KAI Annual Client Survey Fast Track Form	KAI Annual Client Survey Fast Track Form.doc	08/31/2015
Questions for NIAMS Customer Survey 1	Questions for NIAMS Customer Survey1_FINAL.docx	09/01/2015

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