OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

QI Program User Survey

IC 259196 under ICR 202501-0935-001 · OMB 0935-0179.

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

QI Program User Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1 Survey Instrument – QI Software Users Draft survey instrument - QI software users 3_9_23_KHC.docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

Not Required  85 FR 113

400 0
   
Individuals or Households
 
   100 %

  Requested 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 400 0 0 0 0 400
Annual IC Time Burden (Hours) 67 0 0 0 0 67
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” Fast Track 0935-0179 - QI Survey_feedback 1.docx 03/16/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.