OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU)

IC 217747 under ICR 201504-0917-007 · OMB 0917-0036.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU) 54
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0036 Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit Adult Care Unit (ACU) Patient Experience Survey 073015.pdf Yes No Fillable Printable

Health Health Care Services

 

1,200 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,200 0 1,200 0 0 0
Annual IC Time Burden (Hours) 120 0 120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0917-0036, Mini-Supporting Statement for Adult Care Unit (ACU) Patient Experience Survey Mini-Supporting Statement for ACU Patient Experience Survey.doc 08/03/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.