Information Collection

Member Satisfaction Survey - Stony Brook

IC 235413 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⚠️ Notice: This information collection may be referencing outdated material.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
Member Satisfaction Survey - Stony Brook	Form
Member Satisfaction Survey MemberSurveyQA_03.2019.pdf	Form
OMB Fast Track Submission__StonyBrook_3.21.19.docx Request for Aproval	IC Document

IC Title:

Member Satisfaction Survey - Stony Brook

Agency IC Tracking Number:

0920-0953-19AEO

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	Member Satisfaction Survey	MemberSurveyQA_03.2019.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,600

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	10,600	10,600
Annual IC Time Burden (Hours)	1,767	1,767
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Aproval	OMB Fast Track Submission__StonyBrook_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.