Feedback Survey

Assisted Reproductive Technology (ART) Program Reporting System

Documents and Forms

Document Name Document Type
Form 0920-0556 Feedback Survey Form and Instruction
0920-0556 NASS Clinic Feedback Survey AttachmentsAtt C4. NASS 2.0 Clinic Feedback Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Feedback Survey	Agency IC Tracking Number:	0920-0556

Is this a Common Form? No		IC Status: Modified

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	0920-0556	NASS Clinic Feedback Survey	AttachmentsAtt C4. NASS 2.0 Clinic Feedback Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-20-0136, Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 203	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: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	203	-52	255
Annual IC Time Burden (Hours)	7	-2	9
Annual IC Cost Burden (Dollars)	311	-80	391

Documents for IC

Title	Document	Date Uploaded
No associated records found

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