Naval Hospital Rota Access to Care Survey

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
Naval Hospital Rota Access to Care Survey_9.5.2024.docx Other-Survey
0704-0553_OnePager_NH Rota Access to Care Survey_9.09.2024.docx One Pager Justification IC Document
dd3128_NH Rota Access to Care LCB.pdf DD3128 IC Document

Information Collection (IC) Details

IC Title:	Naval Hospital Rota Access to Care Survey	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			Naval Hospital Rota Access to Care Survey_9.5.2024.docx		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: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	524	524

Documents for IC

Title	Document	Date Uploaded
One Pager Justification	0704-0553_OnePager_NH Rota Access to Care Survey_9.09.2024.docx	09/09/2024
DD3128	dd3128_NH Rota Access to Care LCB.pdf	09/09/2024

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