Confer Satisfaction Survey

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

Documents and Forms

Document Name Document Type
Form 0917-0036-86 Confer Satisfaction Survey Form
0917-0036-86 Confer Satisfaction Survey Confer Satisfaction Survey_Draft_2018_1213.docx Form
0917-0036-86 Confer Satisfaction Survey Confer Satisfaction Survey_Draft_2018_1213.docx Form
IHS Tribal Confer Satisfaction.doc IHS Tribal Confer Satisfaction IC Document
IHS Tribal Confer Satisfaction.doc IHS Tribal Confer Satisfaction IC Document

Information Collection (IC) Details

IC Title:	Confer Satisfaction Survey	Agency IC Tracking Number:	86

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0917-0036-86	Confer Satisfaction Survey	Confer Satisfaction Survey_Draft_2018_1213.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	41	41
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IHS Tribal Confer Satisfaction	IHS Tribal Confer Satisfaction.doc	03/21/2019

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