Information Collection

Customer Satisfaction Questions

IC 219411 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 8 Customer Satisfaction Questions Form
8 Customer Satisfaction Survey Questions Appendix 9 Customer Satisfaction Survey Questions_2021.docx Form
8 Customer Satisfaction Survey Questions Appendix 9 Customer Satisfaction Survey Questions_2021.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Customer Satisfaction Questions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	8	Customer Satisfaction Survey Questions	Appendix 9 Customer Satisfaction Survey Questions_2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0156, âRecords of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service	FR Citation: 67 FR 67042

Number of Respondents: 578	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	578	-98	676
Annual IC Time Burden (Hours)	19	-4	23
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.