Information Collection

Office of Public Health Online Customer Satisfaction Survey

IC 219348 under ICR 201503-1090-001 · OMB 1090-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0011 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NPS Office of Public Health Survey.pdf	Other-Survey Instrument
1090-0011 NPS OPH survey Justification.docx Fast Track Justification	IC Document
Sample Email to Customer.pdf Sample Introductory Letters	IC Document

IC Title:

Office of Public Health Online Customer Satisfaction Survey

Agency IC Tracking Number:

FT30

IC Status: New

Obligation to Respond: Mandatory

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
Other-Survey Instrument			NPS Office of Public Health Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 50

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	1,200	1,200
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Justification	1090-0011 NPS OPH survey Justification.docx	12/18/2015
Sample Introductory Letters	Sample Email to Customer.pdf	12/18/2015

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