OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Pharmacy Patient Satisfaction Survey

IC 273652 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Pharmacy In-Person Patient Survey Questions Script_1.14.2025.docx Other-Script
Pharmacy In-Person Patient Survey Questions Script_1.14.2025.docx Other-Script
Pharmacy Telephone Patient Survey Question Script_1.10.2025.docx Other-Script
Pharmacy Telephone Patient Survey Question Script_1.10.2025.docx Other-Script
Fast Track - One Pager Justification for MTF Pharmacy Patient Satisfaction Survey_1.10.2025.docx
One Pager Justification		IC Document
Fast Track - One Pager Justification for MTF Pharmacy Patient Satisfaction Survey_1.10.2025.docx
One Pager Justification		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-Script Yes Yes Fillable Fileable
Other-Script Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 0 0 0 100
Annual IC Time Burden (Hours) 15 0 0 0 0 15
Annual IC Cost Burden (Dollars) 459 0 0 0 0 459

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
One Pager Justification 01/17/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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