Information Collection

BPHC Customer Service Survey

IC 266289 under ICR 202503-0906-002 · OMB 0906-0084.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 BPHC Customer Service Survey	Form and Instruction
Form 1 Customer Feedback Survey BPHC Customer Service Survey	Form and Instruction
1 Customer Feedback Survey BPHC Customer Feedback Survey.docx	Form and Instruction
1 Customer Feedback Survey BPHC Customer Feedback Survey.docx	Form and Instruction
Fast Track Memo- BPHC-Customer Service Survey- 3.25.24.docx Fast Track Memo BPHC Customer Service Survey	IC Document
Fast Track Memo- BPHC-Customer Service Survey- 3.25.24.docx Fast Track Memo BPHC Customer Service Survey	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: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,900

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,900	1,900
Annual IC Time Burden (Hours)	95	95
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Memo BPHC Customer Service Survey		03/25/2024

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

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