Patient Satisfaction Survey Stony Brook

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0953 Patient Satisfaction Survey Stony Brook Form
0920-0953 Patient Satisfaction Survey Att A_PatientSatisfactionSurvey_StonyBrook_08312021.docx Form
RFA_PatientSatisfactionSurvey_StonyBrook.docx Request for Approval_PSS.Stony Brook IC Document

Information Collection (IC) Details

IC Title:	Patient Satisfaction Survey Stony Brook	Agency IC Tracking Number:	0920-0953-18AZL

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	0920-0953	Patient Satisfaction Survey	Att A_PatientSatisfactionSurvey_StonyBrook_08312021.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,000	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	7,000	7,000
Annual IC Time Burden (Hours)	467	467
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval_PSS.Stony Brook	RFA_PatientSatisfactionSurvey_StonyBrook.docx	09/18/2018

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