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Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0935-0179
IC ID: 242601
OMB.report
HHS/AHRQ
OMB 0935-0179
ICR 202310-0935-001
IC 242601
( )
Documents and Forms
Document Name
Document Type
Form 1
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
Form and Instruction
1 Nominator/Partner Survey
Customer Satisfaction Survey_Partner_Nominator_2020.docx
Form and Instruction
1 Nominator/Partner Survey
Customer Satisfaction Survey_Partner_Nominator_2020.docx
Form and Instruction
OMB Cover Letter.docx
Cover Letter
IC Document
OMB Cover Letter.docx
Cover Letter
IC Document
NewParnterEmailInvitation_2020.docx
Email Invitation
IC Document
NewParnterEmailInvitation_2020.docx
Email Invitation
IC Document
Generic Clearance Submission Partner Interview_2020.docx
Supporting Statement
IC Document
Generic Clearance Submission Partner Interview_2020.docx
Supporting Statement
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Partner/Nominator Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
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
Nominator/Partner Survey
Customer Satisfaction Survey_Partner_Nominator_2020.docx
Yes
Yes
Fillable Fileable
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:
20
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
50 %
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
20
0
0
0
0
20
Annual IC Time Burden (Hours)
20
0
0
0
0
20
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Cover Letter
OMB Cover Letter.docx
07/07/2020
Email Invitation
NewParnterEmailInvitation_2020.docx
07/07/2020
Supporting Statement
Generic Clearance Submission Partner Interview_2020.docx
07/07/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.