Information Collection

Exit Survey Part 2 Feedback Survey

IC 236241 under ICR 201905-0925-005 · OMB 0925-0762.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0762 can be found here:

Documents and Forms

Document Name Document Type
Form 3 Exit Survey Part 2 Feedback Survey Form and Instruction
3 Exit Survey Part 2 Feedback Survey Att 2b-Exit Survey Part 2 - Feedback Survey-REV-3.11.19.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Exit Survey Part 2 Feedback Survey	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	3	Exit Survey Part 2 Feedback Survey	Att 2b-Exit Survey Part 2 - Feedback Survey-REV-3.11.19.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: #09â25â0014, âClinical Research; Student Records, HHS/PHS/NIH/OD/OIR/OE	FR Citation: 67 FR 60742

Number of Respondents: 500	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	500	500
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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