Information Collection

NCTN Performance Measurement Survey (NCI)

IC 254262 under ICR 202301-0925-002 · OMB 0925-0766.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0766 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NCTN Performance Measurement Survey (NCI) Form
Form 1 NCTN Performance Measurement Survey (NCI) Form
1 NCTN Survey SurveyMonkey Print Preview - NCTN Survey 6-2-22.pdf Form
1 NCTN Survey SurveyMonkey Print Preview - NCTN Survey 6-2-22.pdf Form
Sub-Study - NCI NCTN Survey Final.docx Sub-Study for NCTN IC Document
Sub-Study - NCI NCTN Survey Final.docx Sub-Study for NCTN IC Document
NCTN Satisfaction Survey Email Invitations - 06.01.2022 (1).docx NCTN survey email invite IC Document
NCTN Satisfaction Survey Email Invitations - 06.01.2022 (1).docx NCTN survey email invite IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NCTN Performance Measurement Survey (NCI)	Agency IC Tracking Number:

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
Form	1	NCTN Survey	SurveyMonkey Print Preview - NCTN Survey 6-2-22.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	183	183
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sub-Study for NCTN	Sub-Study - NCI NCTN Survey Final.docx	06/15/2022
NCTN survey email invite	NCTN Satisfaction Survey Email Invitations - 06.01.2022 (1).docx	06/15/2022

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