NCCIH Webinar Feedback Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 NCCIH Webinar Feedback Survey Form and Instruction
1 Survey NCCIH Technical Assistance WEBINAR survey instrument.docx Form and Instruction
Sample outreach email_NCCIH Technical Asst Webinars customer feedback survey.docx sample outreach email IC Document
Fast track template_ routine customer feedback survey.docx Template IC Document

Information Collection (IC) Details

IC Title:	NCCIH Webinar Feedback 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	Survey	NCCIH Technical Assistance WEBINAR survey instrument.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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
sample outreach email	Sample outreach email_NCCIH Technical Asst Webinars customer feedback survey.docx	03/06/2023
Template	Fast track template_ routine customer feedback survey.docx	03/07/2023

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