OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)

IC 192326 under ICR 202411-2900-011 · OMB 2900-0764.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 10-10070
Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)		 Form and Instruction
Form 10-10070
Dental Care Patient Satisfaction Survey (DPSS) Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)		 Form and Instruction
Form 10-10070
Dental Care Patient Satisfaction Survey (DPSS) - Online Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)		 Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS)
2900-0764_Survey of Healthcare Exp of Pts - Dental Care Patient Satisfaction Survey (DPSS)_rev Jan 2025.docx 		Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS)
2900-0764_Survey of Healthcare Exp of Pts - Dental Care Patient Satisfaction Survey (DPSS)_rev Jan 2025.docx 		Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS) - Online
2900-0764_Survey of Healthcare Exp of Pts - Dental Care Pt Satis Survey_Screenshots_v4_Dec 2024.pptx 		Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS) - Online
2900-0764_Survey of Healthcare Exp of Pts - Dental Care Pt Satis Survey_Screenshots_v4_Dec 2024.pptx 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 10-10070 No   Paper Only
Form and Instruction 10-10070 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50,400 0 0 0 0 50,400
Annual IC Time Burden (Hours) 12,600 0 0 0 0 12,600
Annual IC Cost Burden (Dollars) 0 0 0 0 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].