Assessing Customer Satisfaction with Health, US Report

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
OMB 0920_1050 GenIC Interview Guide Health US Report Federal Gov 20181012.docx Other-Interview guide
Project Determination for ICatalyst.pdf Non-research detemination IC Document
OMB 0920_1050 GenIC Clearance Request Health US Report Federal Gov 20181012.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Assessing Customer Satisfaction with Health, US Report	Agency IC Tracking Number:	0920-1050-19AU

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
Other-Interview guide			OMB 0920_1050 GenIC Interview Guide Health US Report Federal Gov 20181012.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Non-research detemination	Project Determination for ICatalyst.pdf	10/11/2018
Request for Approval	OMB 0920_1050 GenIC Clearance Request Health US Report Federal Gov 20181012.docx	10/15/2018

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