Information Collection

ICARE Dialogues Customer feedback pre- and post-session surveys (OD/OLAW)

IC 246921 under ICR 202103-0925-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 ICARE Dialogues Customer feedback pre- and post-session surveys (OD/OLAW)	Form
1 Pre-session survey part 1_pre-session survey instrument.pdf	Form
1 Pre-session survey part 1_pre-session survey instrument.pdf	Form
2 Pre-session Demographics survey Pre Session Demographics instrument.docx	Form
2 Pre-session Demographics survey Pre Session Demographics instrument.docx	Form
3 Part 2 Post-session survey screenshot part 2_post-session survey instrument.pdf	Form
3 Part 2 Post-session survey screenshot part 2_post-session survey instrument.pdf	Form
Revised ICARE Dialogues fast track -additional demographics questions FINAL (2).docx ICARE Dialogues Customer feedback pre- and post-session surveys	IC Document
Revised ICARE Dialogues fast track -additional demographics questions FINAL (2).docx ICARE Dialogues Customer feedback pre- and post-session surveys	IC Document

IC Title:

ICARE Dialogues Customer feedback pre- and post-session surveys (OD/OLAW)

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Pre-session survey	part 1_pre-session survey instrument.pdf	Yes	Yes	Fillable Fileable
Form	2	Pre-session Demographics survey	Pre Session Demographics instrument.docx	Yes	Yes	Fillable Fileable
Form	3	Part 2 Post-session survey screenshot	part 2_post-session survey instrument.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 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	600	600
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ICARE Dialogues Customer feedback pre- and post-session surveys	Revised ICARE Dialogues fast track -additional demographics questions FINAL (2).docx	04/20/2021

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