Long Island World Trade Center Health Program 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⚠️ Notice: This information collection may be referencing outdated material.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
Long Island World Trade Center Health Program Customer Satisfaction Survey Form and Instruction
Patient Satisfaction Survey Long Island Survey.doc Form and Instruction
Long Island Request form.docx Fast Track GenIC Request IC Document

Information Collection (IC) Details

IC Title:	Long Island World Trade Center Health Program Customer Satisfaction Survey	Agency IC Tracking Number:	0920-0953-16HC

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 and Instruction	NA	Patient Satisfaction Survey	Long Island Survey.doc	NA	No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,200	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	4,200	4,200
Annual IC Time Burden (Hours)	280	280
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track GenIC Request	Long Island Request form.docx	12/14/2015

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