Information Collection

Survey Soliciting Employee Assistance Program (EAP) Customer Satisfaction (ORS/DOHS/OMS/OD)

IC 244759 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⚠️ Notice: This information collection may be referencing outdated material.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 Survey Soliciting Employee Assistance Program (EAP) Customer Satisfaction (ORS/DOHS/OMS/OD)	Form and Instruction
1 EAP COVID Survvey 12012020-AV-EAP COVID Survey (1).docx	Form and Instruction
12012020-AV-EAP COVID fast track template.docx fast track EAP COVID Survey	IC Document

IC Title:

Survey Soliciting Employee Assistance Program (EAP) Customer Satisfaction (ORS/DOHS/OMS/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	EAP COVID Survvey	12012020-AV-EAP COVID Survey (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	400	400
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track EAP COVID Survey	12012020-AV-EAP COVID fast track template.docx	12/03/2020

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