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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 Telecommunication Customer Satisfaction Survey Form
1 Telecommunication survey Telecommunications Survey FINAL.pdf Form
Telecommunications Fast Track Form FINAL.docx Telecommunication fast track IC Document
Telecommunications Survey email.docx email IC Document

Information Collection (IC) Details

IC Title:	Telecommunication Customer Satisfaction Survey	Agency IC Tracking Number:

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	1	Telecommunication survey	Telecommunications Survey FINAL.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,000	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	9,000	9,000
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Telecommunication fast track	Telecommunications Fast Track Form FINAL.docx	05/09/2019
email	Telecommunications Survey email.docx	05/09/2019

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