Information Collection

NYC Health + Hospitals World Trade Center Environmental Health Center Customer Satisfaction Survey

IC 240895 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⚠️ Notice: This information collection may be referencing outdated material.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 NYC Health + Hospitals World Trade Center Environmental Health Center Customer Satisfaction Survey	Form
0920-0953 WTC Environmental Health Center Customer Satisfaction Su NYC H+H Customer Satisfaction Survey Tool 1.28.2020.docx	Form
OMB Fast Track Submission__HH 3.25.20.docx GenIC Request	IC Document

IC Title:

NYC Health + Hospitals World Trade Center Environmental Health Center Customer Satisfaction Survey

Agency IC Tracking Number:

0920-0953-20MB

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	0920-0953	WTC Environmental Health Center Customer Satisfaction Survey	NYC H+H Customer Satisfaction Survey Tool 1.28.2020.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request	OMB Fast Track Submission__HH 3.25.20.docx	03/25/2020

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