Information Collection

Customer Satisfaction Surveys: Fast Track Recall Survey, OMBudsman Survey, State Partner Survey, Hotline Survey, Web Site, and Clearinghouse Survey

IC 29182 under ICR 200712-3041-001 · OMB 3041-0128.

Documents and Forms

Document Name Document Type
OMB0128.pdf Other-null

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Customer Satisfaction Surveys: Fast Track Recall Survey, Ombudsman Survey, State Partner Survey, Hotline Survey, Web Site, and Clearinghouse Survey	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-null			OMB0128.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 684	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 83 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	684	-61	745
Annual IC Time Burden (Hours)	65	15	50
Annual IC Cost Burden (Dollars)	1,821	1,821	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.