Healthcare Teams Cyber Discussion Feedback Survey (NCI)

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⚠️ Notice: This information collection may be referencing outdated material.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 0925-0642 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Healthcare Teams Cyber Discussion Feedback Survey (NCI) Form and Instruction
1 Healthcare Teams CD Survey Healthcare Teams CD Evaluation Survey FINAL 12.6.18.pdf Form and Instruction
Healthcare Teams Fast Track Final 12.6.18 v2.docx Healthcare Teams Fast Track IC Document
Participant_Invitation Letter 12-6-18.docx participant invitation letter IC Document

Information Collection (IC) Details

IC Title:	Healthcare Teams Cyber Discussion Feedback Survey (NCI)	Agency IC Tracking Number:

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 and Instruction	1	Healthcare Teams CD Survey	Healthcare Teams CD Evaluation Survey FINAL 12.6.18.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Healthcare Teams Fast Track	Healthcare Teams Fast Track Final 12.6.18 v2.docx	01/08/2019
participant invitation letter	Participant_Invitation Letter 12-6-18.docx	01/08/2019

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