Information Collection

Website Customer Service Satisfaction Survey

IC 203035 under ICR 201205-0917-002 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Document Name Document Type
Form 0917-0036-002 Website Customer Service Satisfaction Survey Form and Instruction
0917-0036-002 Generic Clearance for the Collection of Qualitative Feed RE OMB Approval Process for Survey Questions 6-12-12.docx www.ihs.gov/AboutIHS/Feedback/PublicSurvey/ Form and Instruction
Mini Supporting Statement for OMB Form 0917-0036-02.pdf Mini Supporting Statement for OMB Form No. 0917-0036-02 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Website Customer Service Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	0917-0036-002	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: Indian Health Service (IHS) Website Customer Service Satisfaction Survey	RE OMB Approval Process for Survey Questions 6-12-12.docx	http://www.ihs.gov/AboutIHS/Feedback/PublicSurvey/	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	125	125
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Mini Supporting Statement for OMB Form No. 0917-0036-02	Mini Supporting Statement for OMB Form 0917-0036-02.pdf	06/21/2012

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