Information Collection

Bereaved Family Member Satisfaction Survey

IC 178992 under ICR 200703-2900-007 · OMB 2900-0701.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0701 can be found here:

Documents and Forms

Document Name Document Type
FATE-lite SURVEY Bereaved Fam Sat 2-7-07.doc Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Bereaved Family Member Satisfaction Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-survey			FATE-lite SURVEY Bereaved Fam Sat 2-7-07.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	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
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	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.