BPHC Customer Service Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

OMB: 0906-0084

IC ID: 266289

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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BPHC Customer Service Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Customer Feedback Survey BPHC Customer Feedback Survey.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,900 0
   
State, Local, and Tribal Governments
 
   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 1,900 0 0 0 0 1,900
Annual IC Time Burden (Hours) 95 0 0 0 0 95
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Fast Track Memo BPHC Customer Service Survey Fast Track Memo- BPHC-Customer Service Survey- 3.25.24.docx 03/25/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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