OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Pharmacy Patient Satisfaction Survey

IC 273652 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms
Document Name
Document Type
Other-Script
Other-Script
Other-Script
Other-Script
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Pharmacy Patient Satisfaction Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Script Pharmacy In-Person Patient Survey Questions Script_1.14.2025.docx Yes Yes Fillable Fileable
Other-Script Pharmacy Telephone Patient Survey Question Script_1.10.2025.docx Yes Yes Fillable Fileable

Defense and National Security Operational Defense

 

100 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 0 0 0 100
Annual IC Time Burden (Hours) 15 0 0 0 0 15
Annual IC Cost Burden (Dollars) 459 0 0 0 0 459

Title Document Date Uploaded
One Pager Justification Fast Track - One Pager Justification for MTF Pharmacy Patient Satisfaction Survey_1.10.2025.docx 01/17/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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