Information Collection

Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division

IC 283238 under ICR 202610-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Nominator/Partner Survey Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division	Form and Instruction
Nominator/Partner Survey Customer Satisfaction Survey_Partner_Nominator_.docx	Form and Instruction
Generic 0935-Short-Form for EPC Customer Satisfaction Survey 10 23 26 final.docx Generic Short Form for EPC Customer Satisfaction Survey	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
Form and Instruction	N/A				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Short Form for EPC Customer Satisfaction Survey		10/23/2026

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

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