Information Collection

North Shore LIJ Customer Satisfaction Survey

IC 219316 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0953 North Shore LIJ Customer Satisfaction Survey	Form and Instruction
0920-0953 Queens2018update Queens2018update.pdf	Form and Instruction
App-QueensPressGaney2.docx App-QueensPressGaney2	IC Document

IC Title:

North Shore LIJ Customer Satisfaction Survey

Agency IC Tracking Number:

16GZ

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	0920-0953	Queens2018update	Queens2018update.pdf		No		Fillable Printable

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
App-QueensPressGaney2	App-QueensPressGaney2.docx	12/17/2015

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