Information Collection

Patient Satisfaction Survey Stony Brook

IC 234904 under ICR 201802-0920-007 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0953 Patient Satisfaction Survey Stony Brook	Form
0920-0953 Participation in WTC Health Program at NYUSOM Clinical C NYU CCE Member Satisfaction Survey 2018 - Spanish Version_OMB.pdf	Form
0920-0953 Participation in WTC Health Program at NYUSOM Clinical C NYU CCE Member Satisfaction Survey 2018_OMB.pdf	Form
OMB Fast Track Submission__NYU.docx Request for Approvsal	IC Document

IC Title:

Patient Satisfaction Survey Stony Brook

Agency IC Tracking Number:

0920-0953-19TF

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	0920-0953	Participation in WTC Health Program at NYUSOM Clinical Center of Excellence	NYU CCE Member Satisfaction Survey 2018 - Spanish Version_OMB.pdf		No		Fillable Fileable
Form	0920-0953	Participation in WTC Health Program at NYUSOM Clinical Center of Excellence (Spanish Version)	NYU CCE Member Satisfaction Survey 2018_OMB.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,800

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	2,800	2,800
Annual IC Time Burden (Hours)	94	94
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approvsal	OMB Fast Track Submission__NYU.docx	02/11/2019

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