Pediatric Patient Perception Survey (CC)

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⚠️ Notice: This information collection may be referencing outdated material.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 Pediatric Patient Perception Survey (CC) Form and Instruction
1 NRC NIH IP P Survey NRC NIH IP P Survey.pdf Form and Instruction
Fast Track Request under GC 0925-0648 CC Pediatric Patient Perception Surveys.doc Pediatric patient Perception Survey fast track IC Document
NIHPIP Cover Letter 1 JKG.pdf NIHPIP Cover letter IC Document

Information Collection (IC) Details

IC Title:	Pediatric Patient Perception Survey (CC)	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	NRC NIH IP P Survey	NRC NIH IP P Survey.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Pediatric patient Perception Survey fast track	Fast Track Request under GC 0925-0648 CC Pediatric Patient Perception Surveys.doc	01/16/2018
NIHPIP Cover letter	NIHPIP Cover Letter 1 JKG.pdf	01/16/2018

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