Information Collection

Office of Medical Services Medical Clearance Process Customer Satisfaction Survey

IC 213943 under ICR 201606-0420-006 · OMB 0420-0545.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0420-0545 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PC-2142 Office of Medical Services Medical Clearance Process Customer Satisfaction Survey	Form
Survey link message-Final.docx	Instruction
PC-2142 OHS Medical Clearance Process Customer Survey Customer satisfaction survey.pdf	Form
OHS Customer Survey Generic Clearance Submission-Final.docx OHS Customer Survey Generic Clearance Submission	IC Document

IC Title:

Office of Medical Services Medical Clearance Process Customer Satisfaction Survey

Agency IC Tracking Number:

IC Status: Unchanged

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	PC-2142	OHS Medical Clearance Process Customer Survey	Customer satisfaction survey.pdf		Yes	Yes	Fillable Fileable
Instruction			Survey link message-Final.docx		Yes	Yes	Fillable Fileable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OHS Customer Survey Generic Clearance Submission	OHS Customer Survey Generic Clearance Submission-Final.docx	11/18/2014

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