Treatment Satisfaction Survey - NYU

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.