Customer Satisfaction Assessment of CDC TB Lab Site Visits

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCHHSTP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1027 can be found here:

Documents and Forms

Document Name Document Type
Customer Satisfaction Assessment of CDC TB Lab Site Visits Form
TB Lab Site Visit Assessment Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation Immediate Follow-up.docx Form
TB Labs Site Visit Assessment Appendix 1_Survey Questions_Site Visit Evaluation_immediate follow-up.docx Form
Template-Customer Satisfaction Site Visit_Online.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Customer Satisfaction Assessment of CDC TB Lab Site Visits	Agency IC Tracking Number:	17SI

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	none	TB Lab Site Visit Assessment	Appendix 2_Web Shots_Survey Questions_Site Visit Evaluation Immediate Follow-up.docx		Yes	Yes	Fillable Fileable
Form	none	TB Labs Site Visit Assessment	Appendix 1_Survey Questions_Site Visit Evaluation_immediate follow-up.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 58	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	58	58
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Template-Customer Satisfaction Site Visit_Online.docx	02/13/2017

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