Patient Perception Surveys Non-Behavioral Health (CC)

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

OMB: 0925-0648

IC ID: 246501

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

View Information Collection (IC)

Patient Perception Surveys Non-Behavioral Health (CC)
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Adult Inpatient Survey Adult Inpatient Survey (1).docx Yes Yes Fillable Fileable
Form 2 Adult and Pediatric Survey Procedure Survey Adult and Pediatric Surgery-Procedure Survey.docx Yes Yes Fillable Fileable
Form 3 Pediatric Inpatient Survey Pediatric Inpatient Survey.docx Yes Yes Fillable Fileable
Form 2 Adult and Pediatric Survey Procedure Survey Adult and Pediatric Surgery-Procedure Survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

4,900 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 39,200 0 0 0 0 39,200
Annual IC Time Burden (Hours) 3,267 0 0 0 0 3,267
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Introductory email-Logon-Welcome Message Introductory Email-Login-Welcome Message (1).docx 03/30/2021
fast track for Patient Perception Surveys Non-Behavioral Health (CC) Fast Track Request Patient Perception Surveys FINAL.docx 03/30/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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