Information Collection

Feedback survey

IC 266241 under ICR 202403-0990-006 · OMB 0990-0491.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0491 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Generic ICR Template_A11 Section 280 Clearance 12 4 23.docx	Other-instruction
Generic ICR Template_A11 Section 280 Clearance 12 4 23.docx	Other-instruction

IC Title:

Feedback survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-instruction			Generic ICR Template_A11 Section 280 Clearance 12 4 23.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000,000	2,000,000
Annual IC Time Burden (Hours)	100,000	100,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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