Information Collection

Clinical Contact Center Survey

IC 242473 under ICR 202003-2900-011 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2020-2900-0876-R1 Clinical Contact Center Survey	Form and Instruction
2020-2900-0876-R1 Clinical Contact Center Survey ECCC_Survey and Emails_V5_061620.pdf	Form and Instruction
Sample Plan Clinical Contact Centers.docx Survey Sample Methodology	IC Document
A-11 Fast-Track Clearance Request Template_Clinical Call Centers_(005).pdf A-11 Requirements Document	IC Document

IC Title:

Clinical Contact Center Survey

Agency IC Tracking Number:

2020-2900-0876-R

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	2020-2900-0876-R1	Clinical Contact Center Survey	ECCC_Survey and Emails_V5_061620.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,688

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	8,688	8,688
Annual IC Time Burden (Hours)	434	434
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey Sample Methodology	Sample Plan Clinical Contact Centers.docx	06/26/2020
A-11 Requirements Document	A-11 Fast-Track Clearance Request Template_Clinical Call Centers_(005).pdf	06/26/2020

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