Information Collection

[CPR]NAC Post-visit Survey

IC 274471 under ICR 202505-0920-006 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25-0053 [CPR]NAC Post-visit Survey	Form
Form 0920-25-0053 Post-site Survey [CPR]NAC Post-visit Survey	Form
0920-25-0053 Post-site Survey Post-site Visit Survey_2025_GenICv2.docx	Form
0920-25-0053 Post-site Survey Post-site Visit Survey_2025_GenICv2.docx	Form
0920-10R50-Request-GenIC NAC Post-site Surveyv2.docx GenIC Request	IC Document
0920-10R50-Request-GenIC NAC Post-site Surveyv2.docx GenIC Request	IC Document

IC Title:

[CPR]NAC Post-visit Survey

Agency IC Tracking Number:

0920-25-0053

IC Status: Unchanged

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
Form	0920-25-0053				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request		03/19/2025

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

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