Information Collection

NITAAC Customer Feedback Questionnaire (OD)

IC 239670 under ICR 202102-0925-005 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NITAAC Customer Feedback Questionnaire (OD)	Form and Instruction
1 NITAAC Survey NITAAC Survey.pdf	Form and Instruction
1 NITAAC Survey NITAAC Survey.pdf	Form and Instruction
Fast-Track - NITAAC 360 Survey_Agency_Stakeholders.docx Fast track request NITAAC 360 Survey Agency Stakeholders	IC Document
Fast-Track - NITAAC 360 Survey_Agency_Stakeholders.docx Fast track request NITAAC 360 Survey Agency Stakeholders	IC Document
Govt Email.docx Govt email	IC Document
Govt Email.docx Govt email	IC Document

IC Title:

NITAAC Customer Feedback Questionnaire (OD)

Agency IC Tracking Number:

IC Status: Unchanged

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	1	NITAAC Survey	NITAAC Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast track request NITAAC 360 Survey Agency Stakeholders	Fast-Track - NITAAC 360 Survey_Agency_Stakeholders.docx	01/30/2020
Govt email	Govt Email.docx	01/30/2020

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