Information Collection

Health Advocate Pilot Project Patient Satisfaction Assessment

IC 228694 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⚠️ Notice: This information collection may be referencing outdated material.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
HA Patient Satisfaction Survey and cover sheet for OMB.docx	Other-Assessment
Health Advocate Survey OMB Request.doc Generic Request - Health Advocate	IC Document

IC Title:

Health Advocate Pilot Project Patient Satisfaction Assessment

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
Other-Assessment			HA Patient Satisfaction Survey and cover sheet for OMB.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request - Health Advocate	Health Advocate Survey OMB Request.doc	10/18/2017

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