Information Collection

Feedback survey

IC 266241 under ICR 202411-0990-001 · OMB 0990-0491.

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: Removed

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					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
	Program Change Due to Agency Discretion	Previously Approved
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].