Information Collection

Customer Service Satisfaction Assessment of TB Laboratory Site Visits conducted by CDC Laboratory Consultants-Online Survey

IC 238972 under ICR 201705-0920-017 · OMB 0920-1027.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Customer Service Satisfaction Assessment of TB Laboratory Site Visits conducted by CDC Laboratory Consultants-Online Survey	Form and Instruction
Appendix 1_Word Version_New Online Survey Instrument.docx	Other-WORD version of instrument con
Site Visit Evaluation: Immediate Follow-up Appendix 2_Web Shots_New Online Survey.docx	Form and Instruction
Generic Clearance Template-Customer Satisfaction Site Visit_Online_New.docx Completed 0920-1027 Template with Project Description	IC Document
Service Delivery Checklist_Customer Satisfaction Site Visit.docx Completed checklist for submissions under 0920-1027	IC Document

IC Title:

Customer Service Satisfaction Assessment of TB Laboratory Site Visits conducted by CDC Laboratory Consultants-Online Survey

Agency IC Tracking Number:

0920-20ED

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 and Instruction	n/a	Site Visit Evaluation: Immediate Follow-up	Appendix 2_Web Shots_New Online Survey.docx		Yes	Yes	Fillable Fileable
Other-WORD version of instrument content to facilitate review of all possible questions			Appendix 1_Word Version_New Online Survey Instrument.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 58

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	58	58
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Completed 0920-1027 Template with Project Description	Generic Clearance Template-Customer Satisfaction Site Visit_Online_New.docx	12/18/2019
Completed checklist for submissions under 0920-1027	Service Delivery Checklist_Customer Satisfaction Site Visit.docx	12/18/2019

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