[NCEZID] NHSN Facility End User Survey

[NCEZID] Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1071 [NCEZID] NHSN Facility End User Survey Form and Instruction
Form 0920-1071 [NCEZID] NHSN Facility End User Survey Form and Instruction
0920-1071 Nhsn 360 Assessment Facility Survey surveysubmission_FINAL_9.26.23.docx Form and Instruction
0920-1071 Nhsn 360 Assessment Facility Survey surveysubmission_FINAL_9.26.23.docx Form and Instruction
Service Delivery Fast Track Template_10.18.23_FINAL (rev).docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0920-1071) IC Document
Service Delivery Fast Track Template_10.18.23_FINAL (rev).docx Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0920-1071) IC Document

Information Collection (IC) Details

IC Title:	[NCEZID] NHSN Facility End User Survey	Agency IC Tracking Number:	0920-1071-24AB

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 and Instruction	0920-1071	Nhsn 360 Assessment Facility Survey	surveysubmission_FINAL_9.26.23.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 33	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	66	66
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB#: 0920-1071)	Service Delivery Fast Track Template_10.18.23_FINAL (rev).docx	10/18/2023

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