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⚠️ Notice: This information collection may be referencing outdated material.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: 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	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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	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.