Information Collection

UDS Reporting Modernization Customer Satisfaction Survey

IC 234766 under ICR 201506-0915-001 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 UDS Reporting Modernization Customer Satisfaction Survey	Form and Instruction
1 UDS Reporting Modernization Customer Satisfaction Survey UDS Reporting Modernization Customer Satisfaction Survey 01.03.19.docx	Form and Instruction
UDS Survey Supporting Statement 01.03.19.docx UDS Survey Supporting Statement	IC Document

IC Title:

UDS Reporting Modernization Customer Satisfaction Survey

Agency IC Tracking Number:

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	1	UDS Reporting Modernization Customer Satisfaction Survey	UDS Reporting Modernization Customer Satisfaction Survey 01.03.19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,469

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	1,469	1,469
Annual IC Time Burden (Hours)	122	122
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
UDS Survey Supporting Statement	UDS Survey Supporting Statement 01.03.19.docx	01/28/2019

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