Fellowship Review Evaluation

Generic Clearance for Satisfaction Surveys of Customers (CSR)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0474 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Fellowship Review Evaluation Form and Instruction
1 Survey FellowshipReviewScreenshot[1].pdf Form and Instruction
FellowshipReview Memo[1].doc FellowshipReview Memo[1] IC Document
CSR_FellowshipReviewSurvey_generic_form[1].doc CSR_FellowshipReviewSurvey_generic_form[1] IC Document

Information Collection (IC) Details

IC Title:	Fellowship Review Evaluation	Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	1	Survey	FellowshipReviewScreenshot[1].pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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 %

	Approved	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	0
Annual IC Time Burden (Hours)	17	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
FellowshipReview Memo[1]	FellowshipReview Memo[1].doc	03/06/2012
CSR_FellowshipReviewSurvey_generic_form[1]	CSR_FellowshipReviewSurvey_generic_form[1].doc	03/06/2012

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