OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Center Program Support Customer Service Survey

IC 238306 under ICR 202012-0915-001 · OMB 0915-0212.

Documents and Forms
Document Name
Document Type
Form
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Health Center Program Support Customer Service Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Sample Customer Service Survey--Salesforce In Test.docx Sample Customer Service Survey--Salesforce In Test.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

201 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 201 0 0 0 0 201
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement - BPHC Customer Service Srvy GENERIC - Supporting Statement_BPHC Customer Service Survey-HCPS 2019_Clean_10232019.docx 10/29/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.