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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Feedback 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
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 %

	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

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.