NCCIH Customer Service Data Collection

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

⚠️ Notice: This information collection may be referencing outdated material.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 NCCIH Customer Service Data Collection Form and Instruction
1 Telephone Survey APPENDIX A Survey Instrument- Telephone_FINAL.doc Form and Instruction
2 Email Survey APPENDIX C Survey Instrument Email_FINAL.doc Form and Instruction
Fast track Template_OMB Control Number 09250648 NCCIH survey 2015_draft_submission v2.doc Fast Track Submission Form IC Document
Appendix B Caller Anonymity_FINAL.doc Caller Anonymity IC Document

Information Collection (IC) Details

IC Title:	NCCIH Customer Service Data Collection	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	Telephone Survey	APPENDIX A Survey Instrument- Telephone_FINAL.doc		No		Paper Only
Form and Instruction	2	Email Survey	APPENDIX C Survey Instrument Email_FINAL.doc		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 412	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	412	412
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Submission Form	Fast track Template_OMB Control Number 09250648 NCCIH survey 2015_draft_submission v2.doc	07/02/2015
Caller Anonymity	Appendix B Caller Anonymity_FINAL.doc	07/02/2015

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