Information Collection

Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division

IC 223276 under ICR 201709-0935-001 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	Form and Instruction
1 Nominator Customer Satisfaction Survey Customer Satisfaction Survey_nominator FINAL.docx	Form and Instruction
Generic Clearance Submission Nominator Interview FINAL.doc Supporting Statement Part A	IC Document
OMB Cover Letter.doc Cover Letter	IC Document

IC Title:

Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division

Agency IC Tracking Number:

IC Status: Unchanged

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	1	Nominator Customer Satisfaction Survey	Customer Satisfaction Survey_nominator FINAL.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A	Generic Clearance Submission Nominator Interview FINAL.doc	08/31/2016
Cover Letter	OMB Cover Letter.doc	08/31/2016

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