Information Collection

Spinal Cord Injury Home Care Patient Satisfaction Survey

IC 229922 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⚠️ Notice: This information collection may be referencing outdated material.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 10-0542 Spinal Cord Injury Home Care Patient Satisfaction Survey	Form and Instruction
10-0542 Spinal Cord Injury – Home Care Patient Satisfaction Surv Spinal Cord Home Care Survey 10-0542A.doc	Form and Instruction
Generic Clearance Submission - Spinal Cord Home Care.doc Generic Request - Spinal Cord Injury Home Care	IC Document

IC Title:

Spinal Cord Injury Home Care Patient Satisfaction Survey

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 and Instruction	10-0542	Spinal Cord Injury â Home Care Patient Satisfaction Survey	Spinal Cord Home Care Survey 10-0542A.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	30	30
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request - Spinal Cord Injury Home Care	Generic Clearance Submission - Spinal Cord Home Care.doc	01/31/2018

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