Information Collection

Network Consolidated Laboratory (NCL) Phlebotomy Service: Patient Satisfaction Questionnaire

IC 228686 under ICR 201710-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0516 Network Consolidated Laboratory (NCL) Phlebotomy Service: Patient Satisfaction Questionnaire	Form
10-0516 Patient Satisfaction Questionnaire: Network Consolidated NCL Patient Satisfaction Questionnaire (final submission to OMB with cover page duplicate paperwork reduction act verbiage 8-7-1	Form
Generic FastTrack Request_ ConsolidLabPhlebotomy.docx Generic Request_NCL	IC Document

IC Title:

Network Consolidated Laboratory (NCL) Phlebotomy Service: Patient Satisfaction Questionnaire

Agency IC Tracking Number:

2900-0770

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	10-0516	Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service	NCL Patient Satisfaction Questionnaire (final submission to OMB with cover page duplicate paperwork reduction act verbiage 8-7-17).docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,612

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,612	8,612
Annual IC Time Burden (Hours)	431	431
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request_NCL	Generic FastTrack Request_ ConsolidLabPhlebotomy.docx	10/19/2017

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