Information Collection

Generic Clearance for NCA, and IG Customer Satisfaction Surveys

IC 42215 under ICR 200612-2900-008 · OMB 2900-0571.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0571 can be found here:

Documents and Forms

Document Name Document Type
2900-0571 IG CBOC Patient Survey.pdf Other-IG CBOC Patient Survey
2900-0571 NCA Survey_English_060106.pdf Other-NCA Satisfaction Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Generic Clearance for NCA, and IG Customer Satisfaction Surveys	Agency IC Tracking Number:

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
Other-IG CBOC Patient Survey			2900-0571 IG CBOC Patient Survey.pdf		No		Paper Only
Other-NCA Satisfaction Survey			2900-0571 NCA Survey_English_060106.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29,650	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	29,650	-440	0	30,090
Annual IC Time Burden (Hours)	13,325	0	-73	13,398
Annual IC Cost Burden (Dollars)	0	0	0	0

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.