Information Collection

HRSA OPTN Patient Service Line Customer Satisfaction Survey

IC 278506 under ICR 202503-0906-002 · OMB 0906-0084.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 HRSA OPTN Helpline Customer Satisfaction Survey HRSA OPTN Patient Service Line Customer Satisfaction Survey	Form
1 HRSA OPTN Helpline Customer Satisfaction Survey HRSA OPTN Help Line Task Order - Customer Satisfaction Survey Questions 12172025.docx	Form
HRSA OPTN Help Line Task Order - Customer Satisfaction Survey Questions 12172025.docx HRSA OPTN Helpline Customer Satisfaction Survey - Fast track memo - Customer Service 12172025	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HRSA OPTN Helpline Customer Satisfaction Survey - Fast track memo - Customer Service 12172025		12/17/2025

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].