Information Collection

Telecommunication Customer Satisfaction Survey

IC 236052 under ICR 201905-0925-001 · OMB 0925-0642.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Telecommunication Customer Satisfaction Survey

Agency IC Tracking Number:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.