NICHD Safe to Sleep® Campaign High-Risk States Outreach Program Customer Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

Documents and Forms

Document Name Document Type
Form 1 NICHD Safe to Sleep® Campaign High-Risk States Outreach Program Customer Satisfaction Survey Form and Instruction
1 High-risk States Outreach Program Customer Satisfaction 0925-0643_High-risk States Outreach Program Customer Satisfaction Survey.docx Form and Instruction
0925-0643_Fast Track_High-Risk States Customer Satisfaction Survey_11-26-14_FINAL-1.doc Fast-Track template High-risk States Outreach Program Customer Satisfaction Survey IC Document

Information Collection (IC) Details

IC Title:	NICHD Safe to Sleep® Campaign High-Risk States Outreach Program 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	High-risk States Outreach Program Customer Satisfaction Survey	0925-0643_High-risk States Outreach Program Customer Satisfaction Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast-Track template High-risk States Outreach Program Customer Satisfaction Survey	0925-0643_Fast Track_High-Risk States Customer Satisfaction Survey_11-26-14_FINAL-1.doc	02/05/2015

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