WTCH Routine Customer Feedback

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0953 WTCH Routine Customer Feedback Form and Instruction
0920-0953 5-WB2811-Evaluation (3) 5-WB2811-Evaluation (3).pdf Form and Instruction
App- CDC Train (004).docx App- CDC Train (004)docx IC Document

Information Collection (IC) Details

IC Title:	WTCH Routine Customer Feedback	Agency IC Tracking Number:	17XZ

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	0920-0953	5-WB2811-Evaluation (3)	5-WB2811-Evaluation (3).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,000	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	16,000	16,000
Annual IC Time Burden (Hours)	1,333	1,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
App- CDC Train (004)docx	App- CDC Train (004).docx	03/09/2017

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