Information Collection

Pediatric Patient Perception Survey (CC)

IC 229752 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⚠️ Notice: This information collection may be referencing outdated material.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 Pediatric Patient Perception Survey (CC)	Form and Instruction
1 NRC NIH IP P Survey NRC NIH IP P Survey.pdf	Form and Instruction
Fast Track Request under GC 0925-0648 CC Pediatric Patient Perception Surveys.doc Pediatric patient Perception Survey fast track	IC Document
NIHPIP Cover Letter 1 JKG.pdf NIHPIP Cover letter	IC Document

IC Title:

Pediatric Patient Perception Survey (CC)

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	NRC NIH IP P Survey	NRC NIH IP P Survey.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Pediatric patient Perception Survey fast track	Fast Track Request under GC 0925-0648 CC Pediatric Patient Perception Surveys.doc	01/16/2018
NIHPIP Cover letter	NIHPIP Cover Letter 1 JKG.pdf	01/16/2018

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