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

Fast Track 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⚠️ Notice: This information collection may be referencing outdated material.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 0990-0379 can be found here:

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.