Information Collection

WTCH Routine Customer Feedback

IC 226013 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⚠️ Notice: This information collection may be referencing outdated material.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 WTCH Routine Customer Feedback	Form and Instruction
0920-0953 5-WB2811-Evaluation (3) 5-WB2811-Evaluation (3).pdf	Form and Instruction
App- CDC Train (004).docx App- CDC Train (004)docx	IC Document

IC Title:

WTCH Routine Customer Feedback

Agency IC Tracking Number:

17XZ

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	5-WB2811-Evaluation (3)	5-WB2811-Evaluation (3).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,000

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	16,000	16,000
Annual IC Time Burden (Hours)	1,333	1,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
App- CDC Train (004)docx	App- CDC Train (004).docx	03/09/2017

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