Survey Soliciting Employee Assistance Program (EAP) Customer Satisfaction (ORS/DOHS/OMS/OD)

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⚠️ Notice: This information collection may be referencing outdated material.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 Survey Soliciting Employee Assistance Program (EAP) Customer Satisfaction (ORS/DOHS/OMS/OD) Form and Instruction
1 EAP COVID Survvey 12012020-AV-EAP COVID Survey (1).docx Form and Instruction
12012020-AV-EAP COVID fast track template.docx fast track EAP COVID Survey IC Document

Information Collection (IC) Details

IC Title:	Survey Soliciting Employee Assistance Program (EAP) Customer Satisfaction (ORS/DOHS/OMS/OD)	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	EAP COVID Survvey	12012020-AV-EAP COVID Survey (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
fast track EAP COVID Survey	12012020-AV-EAP COVID fast track template.docx	12/03/2020

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