Information Collection

The Nationwide Provider Network Customer Satisfaction Survey

IC 219255 under ICR 201505-0920-003 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
The Nationwide Provider Network Customer Satisfaction Survey	Form
Survey Nationwide Provider Network- survey.docx	Form
Nationwide Provider Network- Request form 1215.docx NPN Request	IC Document

IC Title:

The Nationwide Provider Network Customer Satisfaction Survey

Agency IC Tracking Number:

16HA

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	none	Survey	Nationwide Provider Network- survey.docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,100

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	6,300	6,300
Annual IC Time Burden (Hours)	420	420
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NPN Request	Nationwide Provider Network- Request form 1215.docx	12/15/2015

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