North Shore LIJ Customer Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
North Shore LIJ Customer Satisfaction Survey Form
Customer Satisfaction Survey North Shore survey.pdf Form
North Shore fast track.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	North Shore LIJ Customer Satisfaction Survey	Agency IC Tracking Number:	15AZK

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	none	Customer Satisfaction Survey	North Shore survey.pdf		Yes	No	Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	North Shore fast track.docx	07/28/2015

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