OMB
.report
Search
Customer Survey for the World Trade Center Health Program Nutrition Department (Stony Brook)
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
OMB: 0920-0953
IC ID: 236078
OMB.report
HHS/CDC
OMB 0920-0953
ICR 201802-0920-007
IC 236078
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:
2024-06-05 - Extension without change of a currently approved collection
2021-08-11 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Customer Survey for the World Trade Center Health Program Nutrition Department (Stony Brook)
Form and Instruction
World Trade Center Health Program Nutrition Survey
Stonybrook_Nutrition Department Member Survey Final.pdf
Form and Instruction
OMB Fast Track Submission__StonyBrook_Nutrition.docx
Template with Project Description - Nutrition Department Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Customer Survey for the World Trade Center Health Program Nutrition Department (Stony Brook)
Agency IC Tracking Number:
0920-19AYO
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
n/a
World Trade Center Health Program Nutrition Survey
Stonybrook_Nutrition Department Member Survey Final.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
225
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
225
0
225
0
0
0
Annual IC Time Burden (Hours)
38
0
38
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Template with Project Description - Nutrition Department Survey
OMB Fast Track Submission__StonyBrook_Nutrition.docx
05/14/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.