ICARE Dialogues Customer feedback pre- and post- surveys (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⚠️ Notice: This information collection may be referencing outdated material.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 ICARE Dialogues Customer feedback pre- and post- surveys (OD) Form and Instruction
1 ICARE Pre Survey ICARE Dialogues Customer Pre Survey Supporting documents_7_17_20.pdf Form and Instruction
1 ICARE Pre Survey ICARE Dialogues Customer Pre Survey Supporting documents_7_17_20.pdf Form and Instruction
2 ICARE Post Surveys ICARE Dialogues Customer Post Survey Supporting documents_7_17_20.pdf Form and Instruction
2 ICARE Post Surveys ICARE Dialogues Customer Post Survey Supporting documents_7_17_20.pdf Form and Instruction
ICARE Dialogues OMB Application Customer feedback Surveys 7_21_20.docx Template IC Document
ICARE Dialogues OMB Application Customer feedback Surveys 7_21_20.docx Template IC Document

Information Collection (IC) Details

IC Title:	ICARE Dialogues Customer feedback pre- and post- surveys (OD)	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	ICARE Pre Survey	ICARE Dialogues Customer Pre Survey Supporting documents_7_17_20.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	ICARE Post Surveys	ICARE Dialogues Customer Post Survey Supporting documents_7_17_20.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Template	ICARE Dialogues OMB Application Customer feedback Surveys 7_21_20.docx	07/23/2020

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