It's a Noisy Planet. Protect Their Hearing. Campaign: Customer Satisfaction 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⚠️ Notice: This information collection may be referencing outdated material.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 It's a Noisy Planet. Protect Their Hearing. Campaign: Customer Satisfaction Survey Form and Instruction
1 Customer Satisfaction Survey Customer_Satisfaction_Survey_Screenshots.pdf Form and Instruction
2 Parent Survey Parent_Survey_Screenshots.pdf Form and Instruction
Customer_Satisfaction_Survey_Text_file.rtf Customer_Satisfaction_Survey_Text_file IC Document
Parent_Survey_Text_file.rtf Parent_Survey_Text_file IC Document
Customer_Satisfaction_Email_Invite.docx Customer_Satisfaction_Email_Invite IC Document
Parent_Survey_Invite.docx Parent_Survey_Invite IC Document
NoisyPlanet_FastTrackForm 2013 4.8.2013.doc Fast Track Form IC Document

Information Collection (IC) Details

IC Title:	It's a Noisy Planet. Protect Their Hearing. Campaign: Customer Satisfaction 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	Customer Satisfaction Survey	Customer_Satisfaction_Survey_Screenshots.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Parent Survey	Parent_Survey_Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 550	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	550	0	0	0	0	0
Annual IC Time Burden (Hours)	105	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Customer_Satisfaction_Survey_Text_file	Customer_Satisfaction_Survey_Text_file.rtf	03/25/2013
Parent_Survey_Text_file	Parent_Survey_Text_file.rtf	03/25/2013
Customer_Satisfaction_Email_Invite	Customer_Satisfaction_Email_Invite.docx	03/25/2013
Parent_Survey_Invite	Parent_Survey_Invite.docx	03/25/2013
Fast Track Form	NoisyPlanet_FastTrackForm 2013 4.8.2013.doc	04/08/2013

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