The Nationwide Provider Network 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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.