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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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

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.