Information Collection

Mount Sinai World Trade Center Health Program Clinical Center of Excellence Annual Satisfaction Survey

IC 237578 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0953 Mount Sinai World Trade Center Health Program Clinical Center of Excellence Annual Satisfaction Survey	Form and Instruction
0920-0953 WTC Mt. Sinai Medical Center Annual Survey 2019_MSSM_survey.pdf	Form and Instruction
Mount Sinai WTCHP CCE Annual Satisfaction Survey.docx GenIC Request	IC Document

IC Title:

Mount Sinai World Trade Center Health Program Clinical Center of Excellence Annual Satisfaction Survey

Agency IC Tracking Number:

0920-0953-19BOW

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	0920-0953	WTC Mt. Sinai Medical Center Annual Survey	2019_MSSM_survey.pdf	NA	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23,857

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	23,857	23,857
Annual IC Time Burden (Hours)	5,964	5,964
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request	Mount Sinai WTCHP CCE Annual Satisfaction Survey.docx	08/28/2019

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