HC3 Customer Feedback Form

Fast Track Generic Clearance for the Collection of Routine Customer Feedback - HHS Communication

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0459 can be found here:

Documents and Forms

Document Name Document Type
0990-0459 HC3 Customer Feedback Form 05_28.pdf Other-survey
0990-0459 HC3 Fast Track Generic IC Memo Justification05_21_20.docx Memo IC Document

Information Collection (IC) Details

IC Title:	HC3 Customer Feedback Form	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
Other-survey			0990-0459 HC3 Customer Feedback Form 05_28.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Memo	0990-0459 HC3 Fast Track Generic IC Memo Justification05_21_20.docx	05/28/2020

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