Pharmacy Patient Satisfaction Survey

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

Documents and Forms

Document Name Document Type
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
Fast Track - One Pager Justification for MTF Pharmacy Patient Satisfaction Survey_1.10.2025.docx One Pager Justification IC Document

Information Collection (IC) Details

IC Title:	Pharmacy Patient Satisfaction 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-Script			Pharmacy In-Person Patient Survey Questions Script_1.14.2025.docx		Yes	Yes	Fillable Fileable
Other-Script			Pharmacy Telephone Patient Survey Question Script_1.10.2025.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: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	459	459

Documents for IC

Title	Document	Date Uploaded
One Pager Justification	Fast Track - One Pager Justification for MTF Pharmacy Patient Satisfaction Survey_1.10.2025.docx	01/17/2025

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