Information Collection

Customer Survey for the World Trade Center Health Program Nutrition Department (Stony Brook)

IC 236078 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⚠️ Notice: This information collection may be referencing outdated material.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
Customer Survey for the World Trade Center Health Program Nutrition Department (Stony Brook)	Form and Instruction
World Trade Center Health Program Nutrition Survey Stonybrook_Nutrition Department Member Survey Final.pdf	Form and Instruction
OMB Fast Track Submission__StonyBrook_Nutrition.docx Template with Project Description - Nutrition Department Survey	IC Document

IC Title:

Customer Survey for the World Trade Center Health Program Nutrition Department (Stony Brook)

Agency IC Tracking Number:

0920-19AYO

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 and Instruction	n/a	World Trade Center Health Program Nutrition Survey	Stonybrook_Nutrition Department Member Survey Final.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 225

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	225	225
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template with Project Description - Nutrition Department Survey	OMB Fast Track Submission__StonyBrook_Nutrition.docx	05/14/2019

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