Information Collection

NIDCR Website Feedback Surveys

IC 260024 under ICR 202307-0925-002 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NIDCR Website Feedback Surveys	Form
1 In-Page Survey Attachment 1_In-Page Survey_English-Screenshot.docx	Form
1 Site-wide Survey Attachment 4_Site-Wide English-Screenshot.docx	Form
3 In-Page Survey Spanish Attachment 2_In-Page Spanish-Screenshot.docx	Form
4 Site-wide Survey Spanish Attachment 3_Site-Wide Spanish-Screenshot.docx	Form
Template NIDCR_Website Surveys_0925-0648-5.4.23update.docx Template	IC Document
Attachment 5_English Questions.docx English Questions	IC Document
Attachment 6_Spanish Questions.docx Spanish Questions	IC Document

IC Title:

NIDCR Website Feedback Surveys

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	In-Page Survey	Attachment 1_In-Page Survey_English-Screenshot.docx	Yes	Yes	Fillable Fileable
Form	1	Site-wide Survey	Attachment 4_Site-Wide English-Screenshot.docx	Yes	Yes	Fillable Fileable
Form	3	In-Page Survey Spanish	Attachment 2_In-Page Spanish-Screenshot.docx	Yes	Yes	Fillable Fileable
Form	4	Site-wide Survey Spanish	Attachment 3_Site-Wide Spanish-Screenshot.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	40,000	40,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template	Template NIDCR_Website Surveys_0925-0648-5.4.23update.docx	05/04/2023
English Questions	Attachment 5_English Questions.docx	05/04/2023
Spanish Questions	Attachment 6_Spanish Questions.docx	05/04/2023

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