Health Information Technology Patient Satisfaction Survey (CC)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

OMB: 0925-0648

IC ID: 230121

Information Collection (IC) Details

View Information Collection (IC)

Health Information Technology Patient Satisfaction Survey (CC)
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Patient Portal Online Survey Screenshot Patient Portal Online Survey Screenshots 9 23 2016 w OMB control and exp date Final.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,500 0
   
Individuals or Households
 
   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 3,000 0 0 0 0 3,000
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Fast track Health Information Technology Patient Satisfaction Survey (CC) Fast Track Request under GC 0925-0648 CC Portal Survey 9 22 2016 NP (2).doc 02/14/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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