Information Collection

Region IX Office of the Regional Health Administrator (ORHA) External Customer Satisfaction Survey

IC 228504 under ICR 201708-0990-001 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
RIX Webinar Survey - Rev-09-28-17.doc	Other-survey
RIX Survey Approval Application-Rev-09-28-17l.docx memo	IC Document

IC Title:

Region IX Office of the Regional Health Administrator (ORHA) External Customer Satisfaction Survey

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
Other-survey			RIX Webinar Survey - Rev-09-28-17.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	500	500
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
memo	RIX Survey Approval Application-Rev-09-28-17l.docx	09/28/2017

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