New Freedom Initiative Customer Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
nfi satisfaction survey.doc Other-customer survey
NFI CMS Accomplishments.pdf NFI CMS Accomplishments IC Document
nfi Broadcast agenda.doc nfi broadcast agenda IC Document
nfi background .doc nfi background IC Document
nfi members.doc nfi members IC Document
nfi workgroup agenda.doc nfi workgroup agenda example IC Document

Information Collection (IC) Details

IC Title:	New Freedom Initiative Customer 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-customer survey			nfi satisfaction survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	52,050	52,050
Annual IC Time Burden (Hours)	5,075	5,075
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NFI CMS Accomplishments	NFI CMS Accomplishments.pdf	07/18/2007
nfi broadcast agenda	nfi Broadcast agenda.doc	07/18/2007
nfi background	nfi background .doc	07/18/2007
nfi members	nfi members.doc	07/18/2007
nfi workgroup agenda example	nfi workgroup agenda.doc	07/18/2007

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