Information Collection

TeleRehabilitation Enterprise Wide Initiative (TREWI) Patient Satisfaction Survey

IC 236889 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⚠️ Notice: This information collection may be referencing outdated material.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
TREWI Patient Satisfaction Survey_Aug 2019.pdf	Other-Telephone Survey
TREWI Patient Survey_Generic Clearance Supporting Statement.doc TREWI Patient Survey - Generic Clearance Supporting Statement	IC Document

IC Title:

TeleRehabilitation Enterprise Wide Initiative (TREWI) 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
Other-Telephone Survey			TREWI Patient Satisfaction Survey_Aug 2019.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

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	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
TREWI Patient Survey - Generic Clearance Supporting Statement	TREWI Patient Survey_Generic Clearance Supporting Statement.doc	07/15/2019

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