Health Information Technology Patient Satisfaction Survey (CC)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Health Information Technology Patient Satisfaction Survey (CC) Form
1 Patient Portal Survey for Patients NIH Clinical Center Patient Portal Survey for Patients.v001.08182021 (3).docx Form
2 Patient Portal Survey for Workers NIH Clinical Center Patient Portal Survey for Workers.v001.08182021 (2).docx Form
Health Information Technology Patient Satisfaction Survey 2021 (CC) (1).docx Health Information Technology Patient Satisfaction Survey (CC) IC Document
Health Information Technology Patient Satisfaction Survey 2021 email (CC) (2).docx email IC Document

Information Collection (IC) Details

IC Title:	Health Information Technology Patient Satisfaction Survey (CC)	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	Patient Portal Survey for Patients	NIH Clinical Center Patient Portal Survey for Patients.v001.08182021 (3).docx		Yes	Yes	Fillable Fileable
Form	2	Patient Portal Survey for Workers	NIH Clinical Center Patient Portal Survey for Workers.v001.08182021 (2).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48,000	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	48,000	48,000
Annual IC Time Burden (Hours)	4,000	4,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Health Information Technology Patient Satisfaction Survey (CC)	Health Information Technology Patient Satisfaction Survey 2021 (CC) (1).docx	08/25/2021
email	Health Information Technology Patient Satisfaction Survey 2021 email (CC) (2).docx	08/25/2021

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