Division of Grants Management Operations Customer Service Satisfaction Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

Documents and Forms

Document Name Document Type
Form 1 Division of Grants Management Operations Customer Service Satisfaction Survey Form
1 DGMO Customer Service Survey Questions DGMO Customer Service Survey Questions.docx Form
1 DGMO Customer Service Survey Questions DGMO Customer Service Survey Questions.docx Form
SS A - DGMO Customer Service Satisfaction Survey.docx Originial Generic Request IC Document
SS A - DGMO Customer Service Satisfaction Survey.docx Originial Generic Request IC Document

Information Collection (IC) Details

IC Title:	Division of Grants Management Operations Customer Service Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

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	DGMO Customer Service Survey Questions	DGMO Customer Service Survey Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 768	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	768	768
Annual IC Time Burden (Hours)	92	92
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Originial Generic Request	SS A - DGMO Customer Service Satisfaction Survey.docx	01/09/2024

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