Information Collection

The World Trade Center (WTC) Health Program Call Center Satisfaction Survey

IC 219420 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⚠️ Notice: This information collection may be referencing outdated material.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
WTCHP Call Center Stisfaction Survey - Program Members The World Trade Center (WTC) Health Program Call Center Satisfaction Survey	Form and Instruction
WTCHP Call Center Stisfaction Survey - Clinical Centers of Excellence The World Trade Center (WTC) Health Program Call Center Satisfaction Survey	Form and Instruction
WTCHP Call Center Stisfaction Survey - Health Providers The World Trade Center (WTC) Health Program Call Center Satisfaction Survey	Form and Instruction
WTCHP Call Center Stisfaction Survey - Pharmacists The World Trade Center (WTC) Health Program Call Center Satisfaction Survey	Form and Instruction
WTCHP Call Center Stisfaction Survey - Program Members Attachment A- WTCHP Program members.docx	Form and Instruction
WTCHP Call Center Stisfaction Survey - Clinical Centers Attachment B- Clinical Centers of Excellence.docx	Form and Instruction
WTCHP Call Center Stisfaction Survey - Health Providers Attachment C- Health Providers.docx	Form and Instruction
WTCHP Call Center Stisfaction Survey - Pharmacists Attachment D- Pharmacists.docx	Form and Instruction
App-CallCenter Request form.doc GenIC Request	IC Document
WTC Health Program Call Center Customer Satisfaction Survey- Chinese.docx WTCHP Call Center Stisfaction Survey - Chinese	IC Document
WTC Health Program Call Center Customer Satisfaction Survey- Polish.docx WTCHP Call Center Stisfaction Survey - Polish	IC Document
WTC Health Program Call Center Customer Satisfaction Survey- Spanish.docx WTCHP Call Center Stisfaction Survey - Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

The World Trade Center (WTC) Health Program Call Center Satisfaction Survey

Agency IC Tracking Number:

16HN

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	NA	WTCHP Call Center Stisfaction Survey - Program Members	Attachment A- WTCHP Program members.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	WTCHP Call Center Stisfaction Survey - Clinical Centers of Excellence	Attachment B- Clinical Centers of Excellence.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	WTCHP Call Center Stisfaction Survey - Health Providers	Attachment C- Health Providers.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	WTCHP Call Center Stisfaction Survey - Pharmacists	Attachment D- Pharmacists.docx	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26,350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	79,050	79,050
Annual IC Time Burden (Hours)	1,318	1,318
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request	App-CallCenter Request form.doc	12/23/2015
WTCHP Call Center Stisfaction Survey - Chinese	WTC Health Program Call Center Customer Satisfaction Survey- Chinese.docx	12/23/2015
WTCHP Call Center Stisfaction Survey - Polish	WTC Health Program Call Center Customer Satisfaction Survey- Polish.docx	12/23/2015
WTCHP Call Center Stisfaction Survey - Spanish	WTC Health Program Call Center Customer Satisfaction Survey- Spanish.docx	12/23/2015

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