Information Collection

TOC Customer Satisfaction Survey (CIT)

IC 279714 under ICR 202406-0925-001 · OMB 0925-0648.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey TOC Customer Satisfaction Survey (CIT)	Form
1 Survey CIT TOC Customer Satisfaction Survey Collection Instrument.docx	Form
2026 OMS TOC Survey OMB Form.docx Template	IC Document
CIT TOC Customer Satisfaction Survey Email.docx Email Correspondence	IC Document

IC Title:

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
Form	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template		03/31/2026
Email Correspondence		03/31/2026

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

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