Information Collection

NIOSH Customer Satisfaction Survey - Full/Intermediary

IC 229154 under ICR 201711-0920-003 · OMB 0920-0544.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0544 NIOSH Customer Satisfaction Survey - Full/Intermediary	Form and Instruction
0920-0544 CSI Survey Full Intermediary Version Att 3a Full Intermediary.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	0920-0544	CSI Survey Full Intermediary Version	Att 3a Full Intermediary.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 375

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	375	375
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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