Information Collection

National ALS Registry Website Satisfaction Survey

IC 227786 under ICR 201510-0923-001 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ALS Customer Satisfaction Survey National ALS Registry Website Satisfaction Survey	Form
ALS Customer Satisfaction Survey - word National ALS Registry Website Satisfaction Survey	Form
ALS Customer Satisfaction Survey ALSCustomerSatisfactionSurveyedit088217.pdf	Form
ALS Customer Satisfaction Survey - word Attachment A - National ALS Registry Website Satisfaction Survey .docx	Form
0923-0047- Generic Clrnce Qulitve Fdbck Apprvl Frm- Ntnl ALS Rgstry WebSite .pdf Request for Approval	IC Document
NCEH-ATSDR RDF-ALS wbste stsfctn srvy OSSigned.pdf Non-research Determination	IC Document

IC Title:

National ALS Registry Website Satisfaction Survey

Agency IC Tracking Number:

0923-0047-17AYL

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	none	ALS Customer Satisfaction Survey	ALSCustomerSatisfactionSurveyedit088217.pdf		Yes	Yes	Fillable Fileable
Form	none	ALS Customer Satisfaction Survey - word	Attachment A - National ALS Registry Website Satisfaction Survey .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,650

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	2,650	2,650
Annual IC Time Burden (Hours)	221	221
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	0923-0047- Generic Clrnce Qulitve Fdbck Apprvl Frm- Ntnl ALS Rgstry WebSite .pdf	08/02/2017
Non-research Determination	NCEH-ATSDR RDF-ALS wbste stsfctn srvy OSSigned.pdf	08/02/2017

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