Information Collection

Treatment Satisfaction Survey - NYU

IC 235409 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⚠️ Notice: This information collection may be referencing outdated material.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
Treatment Satisfaction Survey - NYU	Form
Treatment Satisfaction Survey - English FINAL treatment survey english.pdf	Form
Treament Satisfaction Survey - Spanish FINAL treatment survey spanish.pdf	Form
OMB Fast Track Submission__NYU_treatment_3.21.19.docx Request for Approval	IC Document

IC Title:

Treatment Satisfaction Survey - NYU

Agency IC Tracking Number:

0920-0953-19AEP

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	none	Treatment Satisfaction Survey - English	FINAL treatment survey english.pdf		Yes	Yes	Fillable Fileable
Form	none	Treament Satisfaction Survey - Spanish	FINAL treatment survey spanish.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	500	500
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	OMB Fast Track Submission__NYU_treatment_3.21.19.docx	03/21/2019

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