Information Collection

Radiology Patient Satisfaction Survey

IC 278141 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Radiology Patient Satisfaction Survey - screenshots_11.14.2025.docx	Other-Web survey
One Pager Justification_Radiology Satisfaction Survey_11.20.2025.docx One Pager Justification	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
Other-Web 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: 12,500

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	12,500	12,500
Annual IC Time Burden (Hours)	417	417
Annual IC Cost Burden (Dollars)	13,619	13,619

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
One Pager Justification		12/02/2025

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

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