Information Collection

ED PQI Feedback Survey

IC 263302 under ICR 202501-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ED PQI Feedback Survey	Form and Instruction
Form 1 ED PQI Feedback Survey ED PQI Feedback Survey	Form and Instruction
1 ED PQI Feedback Survey ED PQI Feedback Survey.docx	Form and Instruction
1 ED PQI Feedback Survey ED PQI Feedback Survey.docx	Form and Instruction
Fast Track Submission Form_ED PQI feedback.docx Fast Track Submission Form_ED PQI feedback	IC Document
Fast Track Submission Form_ED PQI feedback.docx Fast Track Submission Form_ED PQI feedback	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Unchanged

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Submission Form_ED PQI feedback		11/09/2023

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

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