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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.