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Catawba Service Unit Patient Satisfaction Survey
Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys
OMB: 0917-0036
IC ID: 216532
OMB.report
HHS/IHS
OMB 0917-0036
ICR 202201-0917-001
IC 216532
( )
Documents and Forms
Document Name
Document Type
Form 0917-0036
Catawba Service Unit Patient Satisfaction Survey
Form and Instruction
0917-0036 Catawba Service Unit Patient Satisfaction Survey
0917-0036, Catawba Service Unit Patient Satisfaction Survey (IPC and Others), 44.docx
Form and Instruction
0917-0036 Catawba Service Unit Patient Satisfaction Survey
0917-0036, Catawba Service Unit Patient Satisfaction Survey (IPC and Others), 44.docx
Form and Instruction
0917-0036, 2014 Mini-Supporting Statement for CSU Patient Satisfaction Survey.doc
OMB No. 0917-0036, Mini-Supporting Statement for Catawba Service Unit Patient Satisfaction Survey
IC Document
0917-0036, 2014 Mini-Supporting Statement for CSU Patient Satisfaction Survey.doc
OMB No. 0917-0036, Mini-Supporting Statement for Catawba Service Unit Patient Satisfaction Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Catawba Service Unit Patient Satisfaction Survey
Agency IC Tracking Number:
44
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
0917-0036
Catawba Service Unit Patient Satisfaction Survey
0917-0036, Catawba Service Unit Patient Satisfaction Survey (IPC and Others), 44.docx
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
360
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
360
0
0
0
0
360
Annual IC Time Burden (Hours)
30
0
0
0
0
30
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB No. 0917-0036, Mini-Supporting Statement for Catawba Service Unit Patient Satisfaction Survey
0917-0036, 2014 Mini-Supporting Statement for CSU Patient Satisfaction Survey.doc
05/11/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.