Information Collection

Service-Level Measurement- PREVENTS Survey

IC 242424 under ICR 202006-2900-008 · OMB 2900-0880.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0880 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2020-2900-0876-P2 Service-Level Measurement- PREVENTS Survey	Form and Instruction
2020-2900-0876-P2 Service-Level Measurement- PREVENTS Survey PREVENTS Survey v4_6-25-20.pdf	Form and Instruction

IC Title:

Service-Level Measurement- PREVENTS Survey

Agency IC Tracking Number:

2020-2900-0876-P1

Is this a Common Form? No

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-P2	Service-Level Measurement- PREVENTS Survey	PREVENTS Survey v4_6-25-20.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: VEO Customer Experience System of Records

FR Citation: 85 FR 1472

Number of Respondents: 57,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	57,200	57,200
Annual IC Time Burden (Hours)	4,767	4,767
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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