UDS Reporting Modernization Customer Satisfaction Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 UDS Reporting Modernization Customer Satisfaction Survey Form and Instruction
1 UDS Reporting Modernization Customer Satisfaction Survey UDS Reporting Modernization Customer Satisfaction Survey 01.03.19.docx Form and Instruction
UDS Survey Supporting Statement 01.03.19.docx UDS Survey Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	UDS Reporting Modernization Customer Satisfaction Survey	Agency IC Tracking Number:

IC Status: Unchanged

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	UDS Reporting Modernization Customer Satisfaction Survey	UDS Reporting Modernization Customer Satisfaction Survey 01.03.19.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,469	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,469	1,469
Annual IC Time Burden (Hours)	122	122
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
UDS Survey Supporting Statement	UDS Survey Supporting Statement 01.03.19.docx	01/28/2019

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