Information Collection

ASA24 Customer Satisfaction Survey (NCI)

IC 231817 under ICR 201702-0925-001 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ASA24 Customer Satisfaction Survey (NCI)	Form
1 ASA24 User Survey ASA24 User Survey_rev 6.13.18.pdf	Form
Fast Track_ASA24 6.4.18.docx Fast Track ASA24	IC Document
Please complete short survey to help improve ASA24 (initial email).msg email to respondents	IC Document

IC Title:

ASA24 Customer Satisfaction Survey (NCI)

Agency IC Tracking Number:

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	1	ASA24 User Survey	ASA24 User Survey_rev 6.13.18.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,485

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	1,485	1,485
Annual IC Time Burden (Hours)	248	248
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track ASA24	Fast Track_ASA24 6.4.18.docx	06/14/2018
email to respondents	Please complete short survey to help improve ASA24 (initial email).msg	06/14/2018

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