Customer Satisfaction Surveys for the Health Literacy Training Program

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Customer Satisfaction Surveys for the Health Literacy Training Program Form
1 Health Literacy Training for Health Professionals Custom CustomerSatisfactionSurvey_HPTraining_final.doc Form
2 Health Literacy Training of Trainers Customer Satisfacti CustomerSatisfactionSurvey_ToT_final.doc Form
GENERIC Customer Satisfaction - Supporting Statement_JSIV2.docx Health Literacy Project\GENERIC Customer Satisfaction - Supporting Statement_JSIV2 IC Document

Information Collection (IC) Details

IC Title:	Customer Satisfaction Surveys for the Health Literacy Training Program	Agency IC Tracking Number:

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	1	Health Literacy Training for Health Professionals Customer Satisfaction Survey	CustomerSatisfactionSurvey_HPTraining_final.doc		No		Paper Only
Form	2	Health Literacy Training of Trainers Customer Satisfaction Survey	CustomerSatisfactionSurvey_ToT_final.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 4 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,600	2,600
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Health Literacy Project\GENERIC Customer Satisfaction - Supporting Statement_JSIV2	GENERIC Customer Satisfaction - Supporting Statement_JSIV2.docx	07/06/2015

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