Customer Satisfaction On-line Survey for Applicants: Officials of Host Institutions

Process Evaluation of the NIH Director's Early Independence Award Program (EIA)

Documents and Forms

Document Name Document Type
Form Attachment A3.4 Customer Satisfaction On-line Survey for Applicants: Officials of Host Institutions Form and Instruction
Attachment A3.4 Screenshots for Customer Satisfaction On-line Host Surve Attachment A.3.4 - Screenshots Customer Satisfaction Online Survey for Applicants (Host Institutions).pdf Form and Instruction
Attachment A.3.2 - Customer Satisfaction Online Survey for Applicants (Host Institutions).doc Attachment A3.2 Customer Satisfaction Host Survey (Paper Version) IC Document
Attachment B.1.2 - Protocols Customer Satisfaction Survey Host Institutions.doc On-line Survey Protocols IC Document

Information Collection (IC) Details

IC Title:	Customer Satisfaction On-line Survey for Applicants: Officials of Host Institutions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Attachment A3.4	Screenshots for Customer Satisfaction On-line Host Survey	Attachment A.3.4 - Screenshots Customer Satisfaction Online Survey for Applicants (Host Institutions).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-25-0156 Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD	FR Citation: 67 FR 60742

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment A3.2 Customer Satisfaction Host Survey (Paper Version)	Attachment A.3.2 - Customer Satisfaction Online Survey for Applicants (Host Institutions).doc	09/17/2012
On-line Survey Protocols	Attachment B.1.2 - Protocols Customer Satisfaction Survey Host Institutions.doc	09/26/2012

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