Information Collection

Pharmacy Program Satisfaction Survey

IC 253188 under ICR 202203-0704-006 · OMB 0704-0553.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0553 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pharmacy Satisfaction Survey Script_3.30.22.pdf	Other-Survey
One Pager Justification_Pharmacy Program Satisfaction Survey_4.7.2022.docx One Pager - Pharmacy Program Satisfaction Survey	IC Document

IC Title:

Pharmacy Program Satisfaction Survey

Agency IC Tracking Number:

IC Status: New

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
Other-Survey			Pharmacy Satisfaction Survey Script_3.30.22.pdf		No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 340

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	340	340
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	2,178	2,178

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
One Pager - Pharmacy Program Satisfaction Survey	One Pager Justification_Pharmacy Program Satisfaction Survey_4.7.2022.docx	05/03/2022

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