Customer Satisfaction Survey for Rural Health Day 2021 Seminar (NCCIH)

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⚠️ Notice: This information collection may be referencing outdated material.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 Customer Satisfaction Survey for Rural Health Day 2021 Seminar (NCCIH) Form
1 Rural Health Day survey RuralHealthDaySurvey_v3.pdf Form
Fast Track Template_Survey for Rural Health Day_v4.docx fast track for Rural Health Day IC Document

Information Collection (IC) Details

IC Title:	Customer Satisfaction Survey for Rural Health Day 2021 Seminar (NCCIH)	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	Rural Health Day survey	RuralHealthDaySurvey_v3.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 942	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	942	942
Annual IC Time Burden (Hours)	157	157
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
fast track for Rural Health Day	Fast Track Template_Survey for Rural Health Day_v4.docx	10/22/2021

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