Anticoagulation Clinic Patient Satisfaction Survey

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

OMB: 0917-0036

IC ID: 248810

Information Collection (IC) Details

View Information Collection (IC)

Anticoagulation Clinic Patient Satisfaction Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0036 Anticoagulation Clinic Patient Satisfaction Survey Anticoagulation Services Patient Satisfaction Survey 8.10.21.docx No   Printable Only

Health Public Health Monitoring

 

15 0
   
Individuals or Households
 
   0 %

  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 15 0 0 0 0 15
Annual IC Time Burden (Hours) 2 0 0 0 0 2
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement Generic Clearance Submission - WWKMHCC Anticoagulation Clinic Patient Satisfaction Survey 7-21.docx 08/11/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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