Information Collection

Telephone Clients Demographic & Customer Satisfaction Questions

IC 219409 under ICR 202201-0925-001 · OMB 0925-0208.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0208 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Telephone Clients Demographic & Customer Satisfaction Questions	Form and Instruction
2 Customer Service and Demographic Questions Appendix 1A Customer Service and Demographic Questions_updated AG.docx	Form and Instruction
2 Customer Service and Demographic Questions Appendix 1A Customer Service and Demographic Questions_updated AG.docx	Form and Instruction

IC Title:

Telephone Clients Demographic & Customer Satisfaction Questions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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 and Instruction	2	Customer Service and Demographic Questions	Appendix 1A Customer Service and Demographic Questions_updated AG.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-13,100	13,100
Annual IC Time Burden (Hours)	-437	437
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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