Anticoagulation Manager Mobile App User Feedback

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

Documents and Forms

Document Name Document Type
Anticoagulation Manager Mobile App User Feedback Form
Anticoagulation Manager Mobile App User Survey 04_ACM Survey Instrument screen shot 02-02-2018.pdf Form
01_Request for approval form CLIHC ACM 02-02-2018.docx Request for Approval IC Document
03_Screen shot of push notification for ACM survey 02-02-2018.pdf Notification for App IC Document
02_Screen shot of ACM Take User Survey page 02-02-2018.pdf Survey invitation IC Document

Information Collection (IC) Details

IC Title:	Anticoagulation Manager Mobile App User Feedback	Agency IC Tracking Number:	0920-0974-18OE

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	Anticoagulation Manager Mobile App User Survey	04_ACM Survey Instrument screen shot 02-02-2018.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	01_Request for approval form CLIHC ACM 02-02-2018.docx	02/07/2018
Notification for App	03_Screen shot of push notification for ACM survey 02-02-2018.pdf	02/07/2018
Survey invitation	02_Screen shot of ACM Take User Survey page 02-02-2018.pdf	02/07/2018

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