SUNY – Stony Brook CCE WTC Health Program Customer Satisfaction Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 SUNY – Stony Brook CCE WTC Health Program Customer Satisfaction Survey Form and Instruction
0920-0953 Member Survey - 2018 Member Survey FINAL_SUNY.PDF Form and Instruction
App- Stony Brook Cust Satisfaction Survey 08MAR2018.doc GenIC Request Template IC Document

Information Collection (IC) Details

IC Title:	SUNY – Stony Brook CCE WTC Health Program Customer Satisfaction Survey	Agency IC Tracking Number:	0920-0953-18TZ

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	Member Survey - 2018	Member Survey FINAL_SUNY.PDF	NA	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,900	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,900	1,900
Annual IC Time Burden (Hours)	158	158
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request Template	App- Stony Brook Cust Satisfaction Survey 08MAR2018.doc	03/08/2018

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