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

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⚠️ Notice: This information collection may be referencing outdated material.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
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

Information Collection (IC) Details

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:

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 %

	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

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.