ASA24 Customer Satisfaction Survey (NCI)

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⚠️ Notice: This information collection may be referencing outdated material.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 0925-0642 can be found here:

Documents and Forms

Document Name Document Type
Form 1 ASA24 Customer Satisfaction Survey (NCI) Form
1 ASA24 User Survey ASA24 User Survey_rev 6.13.18.pdf Form
Fast Track_ASA24 6.4.18.docx Fast Track ASA24 IC Document
Please complete short survey to help improve ASA24 (initial email).msg email to respondents IC Document

Information Collection (IC) Details

IC Title:	ASA24 Customer Satisfaction Survey (NCI)	Agency IC Tracking Number:

IC Status: Unchanged

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	1	ASA24 User Survey	ASA24 User Survey_rev 6.13.18.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,485	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,485	1,485
Annual IC Time Burden (Hours)	248	248
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track ASA24	Fast Track_ASA24 6.4.18.docx	06/14/2018
email to respondents	Please complete short survey to help improve ASA24 (initial email).msg	06/14/2018

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