National ALS Registry Website Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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

Information Collection (IC) Details

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:

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 %

	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

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.