Information Collection

2021 Primo VE Service Feedback Survey (NLM)

IC 247270 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⚠️ Notice: This information collection may be referencing outdated material.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 2021 Primo VE Service Feedback Survey (NLM)	Form
1 PrimoVE survey instrument NLM 2021 PrimoVE Survey Instrument.pdf	Form
1 PrimoVE survey instrument NLM 2021 PrimoVE Survey Instrument.pdf	Form
NLM Fast Track ICR _2021 Primo VE Service Feedback Survey.docx NLM 2021 Primo VE Service Feedback Survey	IC Document
NLM Fast Track ICR _2021 Primo VE Service Feedback Survey.docx NLM 2021 Primo VE Service Feedback Survey	IC Document

IC Title:

2021 Primo VE Service Feedback Survey (NLM)

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	PrimoVE survey instrument	NLM 2021 PrimoVE 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: 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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NLM 2021 Primo VE Service Feedback Survey	NLM Fast Track ICR _2021 Primo VE Service Feedback Survey.docx	05/10/2021

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