Information Collection

NITAAC Customer Feedback Questionnaire (OD)

IC 239670 under ICR 201906-0925-001 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NITAAC Customer Feedback Questionnaire (OD)	Form and Instruction
1 NITAAC Survey NITAAC Survey.pdf	Form and Instruction
Fast-Track - NITAAC 360 Survey_Agency_Stakeholders.docx Fast track request NITAAC 360 Survey Agency Stakeholders	IC Document
Govt Email.docx Govt email	IC Document

IC Title:

NITAAC Customer Feedback Questionnaire (OD)

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 and Instruction	1	NITAAC Survey	NITAAC Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	100	100
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast track request NITAAC 360 Survey Agency Stakeholders	Fast-Track - NITAAC 360 Survey_Agency_Stakeholders.docx	01/30/2020
Govt email	Govt Email.docx	01/30/2020

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