NCAAM Clearinghouse Telephone Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (OD/OER)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NCAAM Clearinghouse Telephone Survey Form and Instruction
1 NCAAM Clearinghouse Telephone Survey APPENDIX A Survey Instrument- rev 4.1.2013.doc Form and Instruction
Fast track Template_NCCAM phone survey 2013_FINAL[2].doc Fast Track Template IC Document
Appendix B Caller Anonymity.doc Appendix B Caller Anonymity IC Document

Information Collection (IC) Details

IC Title:	NCAAM Clearinghouse Telephone Survey	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	NCAAM Clearinghouse Telephone Survey	APPENDIX A Survey Instrument- rev 4.1.2013.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 275	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	275	0	0	0	0	0
Annual IC Time Burden (Hours)	23	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Template	Fast track Template_NCCAM phone survey 2013_FINAL[2].doc	04/01/2013
Appendix B Caller Anonymity	Appendix B Caller Anonymity.doc	04/01/2013

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