Telebehavioral Health 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: 225049

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Telebehavioral Health Patient Satisfaction Survey 53
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0917-0036 Telebehavioral Health Patient Satisfaction Survey Catawba Service Unit Telebehavioral Health Survey.docx No   Paper Only

Health Health Care Services

 

40 1
   
Individuals or Households
 
   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 40 0 0 0 0 40
Annual IC Time Burden (Hours) 3 0 0 0 0 3
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Request for Approval - Telebehavioral Health Patient Satisfaction Survey Telebehavioral Health Survey Request for Approval Form.docx 01/06/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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