Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1050 Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement Form
0920-1050 Post Site Visit Survey Post site visit survey questions_Clearance.docx Form
0920-1050-Customer Service GenIC Clearance Template (Final 5.3)_Post visit survey_US NAC_201216.docx Customer Service Clearance Template IC Document

Information Collection (IC) Details

IC Title:	Post visit survey for facility evaluation of US National Authority for Containment of Poliovirus (NAC) performance and improvement	Agency IC Tracking Number:	0920-1050-21BR

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	0920-1050	Post Site Visit Survey	Post site visit survey questions_Clearance.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Customer Service Clearance Template	0920-1050-Customer Service GenIC Clearance Template (Final 5.3)_Post visit survey_US NAC_201216.docx	12/17/2020

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