Information Collection

BPHC Customer Service Survey Helpline & Answers

IC 223191 under ICR 201502-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 BPHC Customer Service Survey Helpline & Answers	Form
1 Survey Instrument Helpline Survey Instrument Helpline 08.16.16.pdf	Form
2 Survey Instrument Answers Survey Instrument Answers 08.16.16.pdf	Form
Survey Supporting Statement 08.16.16 sd.docx Supporting Statement	IC Document

IC Title:

BPHC Customer Service Survey Helpline & Answers

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	1	Survey Instrument Helpline	Survey Instrument Helpline 08.16.16.pdf		Yes	Yes	Fillable Fileable
Form	2	Survey Instrument Answers	Survey Instrument Answers 08.16.16.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,315

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	2,315	2,315
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Survey Supporting Statement 08.16.16 sd.docx	08/25/2016

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