View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	The World Trade Center Health Program Customer Satisfaction Survey	Agency IC Tracking Number:	0920-095314AOR

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	WTC Customer Satisfaction Survey	WTC Customer Satisfaction Survey.doc		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0953	WTC screen shots	WTC screen shots.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Federal Register Citation	FR Citation: 79 FR 24432

Number of Respondents: 6,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

	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	6,500	0	6,500	0	0	0
Annual IC Time Burden (Hours)	1,083	0	1,083	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
English version	English version.docx	07/16/2014
Spanish version	Spanish version.docx	07/16/2014
Polish version	Polish version.doc	07/16/2014
Chinese version	Chinese version.doc	07/16/2014

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