Information Collection

Executive Health Services Feedback Survey

IC 253189 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MAX Survey - Senior Leader Executive Health Services Satisfaction Survey_3.9.2022.pdf	Other-Survey
MAX Survey - Senior Leader Executive Health Services Satisfaction Survey_3.9.2022.pdf	Other-Survey
OnePager_Executive Health Survey_3.17.2022.docx One Pager Executive Health Services Feedback Survey	IC Document
OnePager_Executive Health Survey_3.17.2022.docx One Pager Executive Health Services Feedback Survey	IC Document
Example of Email sent to respondents.pdf Email Sent to Respondents	IC Document
Example of Email sent to respondents.pdf Email Sent to Respondents	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Removed

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
Other-Survey					Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-100	100
Annual IC Time Burden (Hours)	-8	8
Annual IC Cost Burden (Dollars)	-166	166

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
One Pager Executive Health Services Feedback Survey		05/03/2022
Email Sent to Respondents		05/03/2022

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

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