2012 IRG Stakeholder Survey

Generic Clearance for Satisfaction Surveys of Customers (CSR)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0474 can be found here:

Documents and Forms

Document Name Document Type
Form 1 2012 IRG Stakeholder Survey Form and Instruction
1 2012 IRG Stakeholder Survey 2012 IRG Stakeholder Survey Screenshot 4.2013.pdf Form and Instruction
IRG Stakeholder Memo ver2 4.2103.doc 2012 IRG Stakeholder Survey Justification Memo IC Document
2012 IRG StakeholderSurvey Generic Template MemoCSR ver2 4.2013.doc 2012 IRH Stakeholder Survey - Generic Template IC Document

Information Collection (IC) Details

IC Title:	2012 IRG Stakeholder Survey	Agency IC Tracking Number:

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
Form and Instruction	1	2012 IRG Stakeholder Survey	2012 IRG Stakeholder Survey Screenshot 4.2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	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	180	0	0	0	0	0
Annual IC Time Burden (Hours)	45	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
2012 IRG Stakeholder Survey Justification Memo	IRG Stakeholder Memo ver2 4.2103.doc	04/15/2013
2012 IRH Stakeholder Survey - Generic Template	2012 IRG StakeholderSurvey Generic Template MemoCSR ver2 4.2013.doc	04/15/2013

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