Sponsor and Payor Feedback for the Early Payor Feedback Program (CDRH)

Customer/Partner Satisfaction Service Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0360 can be found here:

Documents and Forms

Document Name Document Type
Payor and Sponsor Intro Scripts and Emails.docx Other-Scripts and Emails
Payor and Sponsor Intro Scripts and Emails.docx Other-Scripts and Emails
Survey Questions.docx Other-Questionnaire
Survey Questions.docx Other-Questionnaire
0360 OMB Approval Memo - Sponsor Payor Feedback 2021.docx OMB Approval Memo IC Document
0360 OMB Approval Memo - Sponsor Payor Feedback 2021.docx OMB Approval Memo IC Document

Information Collection (IC) Details

IC Title:	Sponsor and Payor Feedback for the Early Payor Feedback Program (CDRH)	Agency IC Tracking Number:	CDRH

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
Other-Scripts and Emails			Payor and Sponsor Intro Scripts and Emails.docx		Yes	No	Printable Only
Other-Questionnaire			Survey Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	22	22
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Approval Memo	0360 OMB Approval Memo - Sponsor Payor Feedback 2021.docx	09/17/2021

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