Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division

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

OMB: 0935-0179

IC ID: 228948

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Patient Key Informant Customer Satisfaction Survey for the Evidence Based Practice Center (EPC) Division
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Patient Key Informants Customer Satisfaction Survey_Patient FINAL.docx Yes Yes Fillable Fileable

Health Health Care Services

 

40 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 40 0 0 0 0 40
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Cover Letter OMB Cover Letter_patientKI.doc 11/07/2017
Supporting Statement Generic Clearance Submission Patient Questions FINAL.doc 11/07/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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