Information Collection

ICARE Dialogues Customer feedback pre- and post- surveys (Session 10 and 11) (OLAW/OD)

IC 243802 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⚠️ Notice: This information collection may be referencing outdated material.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 ICARE Dialogues Customer feedback pre- and post- surveys (Session 10 and 11) (OLAW/OD)	Form and Instruction
1 ICARE Dialogues Customer Pre-Survey for sessions 10 and ICARE Dialogues Customer Pre Survey Supporting documents sessions 10 and 11.pdf	Form and Instruction
2 ICARE Dialogues Customer Post-Survey for session 10 and ICARE Dialogues Customer Post Survey Supporting documents sessions 10 and 11.pdf	Form
ICARE Dialogues OMB Approval App Customer feedback Surveys Sessions 10 and 11.docx ICARE Dialogues Customer feedback pre- and post- surveys (Session 10 and 11)	IC Document

IC Title:

ICARE Dialogues Customer feedback pre- and post- surveys (Session 10 and 11) (OLAW/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	ICARE Dialogues Customer Pre-Survey for sessions 10 and 11	ICARE Dialogues Customer Pre Survey Supporting documents sessions 10 and 11.pdf		Yes	Yes	Fillable Fileable
Form	2	ICARE Dialogues Customer Post-Survey for session 10 and 11	ICARE Dialogues Customer Post Survey Supporting documents sessions 10 and 11.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)	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 (Session 10 and 11)	ICARE Dialogues OMB Approval App Customer feedback Surveys Sessions 10 and 11.docx	09/28/2020

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