Information Collection

ICARE Dialogues Customer feedback pre- and post- surveys (OD)

IC 242631 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⚠️ Notice: This information collection may be referencing outdated material.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 2 ICARE Dialogues Customer feedback pre- and post- surveys (OD)	Form and Instruction
1 ICARE Dialogues Customer feedback pre-surveys ICARE Dialogues Customer Pre Survey Supporting documents_7_8_20.pdf	Form and Instruction
2 ICARE Dialogues Customer feedback post- surveys ICARE Dialogues Customer Post Survey Supporting documents_7_8_20.pdf	Form and Instruction
ICARE Dialogues OMB Approval App Customer feedback template.docx ICARE Dialogues Customer feedback pre- and post- surveys template	IC Document

IC Title:

ICARE Dialogues Customer feedback pre- and post- surveys (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	2	ICARE Dialogues Customer feedback post- surveys	ICARE Dialogues Customer Post Survey Supporting documents_7_8_20.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	1	ICARE Dialogues Customer feedback pre-surveys	ICARE Dialogues Customer Pre Survey Supporting documents_7_8_20.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ICARE Dialogues Customer feedback pre- and post- surveys template	ICARE Dialogues OMB Approval App Customer feedback template.docx	07/08/2020

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