Information Collection

Whole Person Health Satisfaction Survey (NCI)

IC 280644 under ICR 202406-0925-001 · OMB 0925-0648.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Survey 1 Whole Person Health Satisfaction Survey (NCI)	Form and Instruction
Survey 1 Whole Person Health (WPH) Survey (NCI).pdf	Form and Instruction
0925-0648 Whole Person Health (NCI).docx 0925-0648 Whole Person Health (NCI)	IC Document
Whole Person Health Email (NCI).docx Whole Person Health Email (NCI)	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 and Instruction	Survey				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0925-0648 Whole Person Health (NCI)		05/29/2026
Whole Person Health Email (NCI)		05/29/2026

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

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