Information Collection

Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit

IC 217932 under ICR 201504-0917-007 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0036 Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit	Form and Instruction
0917-0036 Obstetrical Care Unit (OCU) Patient Experience Suvey, Ch 0917-0036, Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit.pdf	Form and Instruction
0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU).doc 0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU)	IC Document

IC Title:

Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit

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	0917-0036	Obstetrical Care Unit (OCU) Patient Experience Suvey, Chinle Service Unit (CSU)	0917-0036, Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 480

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	480	480
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU)	0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU).doc	08/19/2015

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