Michael DeBakey Satisfation Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 10-0476 Michael DeBakey Satisfation Survey Form and Instruction
10-0476 Michael E. Debakey Home Care Program Michael DeBakey Satisfaction Survey_011018.docx Form and Instruction
Michael DeBakey Generic Request_011018.docx Generic Request_ Michael DeBakey Satisfaction Survey IC Document

Information Collection (IC) Details

IC Title:	Michael DeBakey Satisfation Survey	Agency IC Tracking Number:	2900-0770

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
Form and Instruction	10-0476	Michael E. Debakey Home Care Program	Michael DeBakey Satisfaction Survey_011018.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Request_ Michael DeBakey Satisfaction Survey	Michael DeBakey Generic Request_011018.docx	02/14/2018

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