Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

OMB: 0935-0179

IC ID: 228950

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Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Stakeholder Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Program
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Stakeholders Customer Satisfaction Survey_stakeholder FINAL.docx Yes Yes Fillable Fileable

Health Health Care Services

 

400 0
   
Individuals or Households
 
   100 %

  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 400 0 0 0 0 400
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter OMB Cover Letter_stakeholder.doc 11/07/2017
Supporting Statement Generic Clearance Submission_Stakeholders FINAL review.doc 11/07/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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