Information Collection

.ICARE Dialogues Customer feedback pre- and post-session surveys (OLAW/OD)

IC 245553 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⚠️ Notice: This information collection may be referencing outdated material.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 Part 1 Pre-session .ICARE Dialogues Customer feedback pre- and post-session surveys (OLAW/OD)	Form
Form 2 Survey Part 2 Post-session .ICARE Dialogues Customer feedback pre- and post-session surveys (OLAW/OD)	Form
1 Survey Part 1 Pre-session Supporting document Survey part 1_pre-session survey_.pdf	Form
2 Survey Part 2 Post-session Supporting document Survey part 2_post-session survey.pdf	Form
ICARE Dialogues OMB Approval App Customer feedback Surveys Sessions 12 through 19.docx Fast track ICARE Dialogues feedback sessions 12 through 19	IC Document

IC Title:

.ICARE Dialogues Customer feedback pre- and post-session surveys (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	1				Yes	Yes	Fillable Fileable
Form	2				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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 ICARE Dialogues feedback sessions 12 through 19		02/02/2021

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

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