Mount Sinai WTC Health Program Clinical Center of Excellence After Visit Questionnaire

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⚠️ Notice: This information collection may be referencing outdated material.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
2019-After Visit Card_02_0120319.pdf Other-WORD.doc
OMB Fast Track Submission__Mount Sinai After Visit Survey (1).docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Mount Sinai WTC Health Program Clinical Center of Excellence After Visit Questionnaire	Agency IC Tracking Number:	0920-0953-20DK

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
Other-WORD.doc			2019-After Visit Card_02_0120319.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,196	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,196	3,196
Annual IC Time Burden (Hours)	266	266
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	OMB Fast Track Submission__Mount Sinai After Visit Survey (1).docx	12/16/2019

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