Office of Minority Health's Customer Satisfaction Survey

Customer/Partner Service Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0360 can be found here:

Documents and Forms

Document Name Document Type
OMH Survey Questions.docx Other-Survey
0360 Justification Memo for OMB - OMH Survey.doc OMB Justification Memo IC Document

Information Collection (IC) Details

IC Title:	Office of Minority Health's Customer Satisfaction Survey	Agency IC Tracking Number:	OC

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
Other-Survey			OMH Survey Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,300	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	1,300	1,300
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Justification Memo	0360 Justification Memo for OMB - OMH Survey.doc	06/26/2017

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