View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Patient Perception Survey (CC)	Agency IC Tracking Number:

IC Status: Unchanged

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	1	NIH Inpatient Mock-up - NRC Health	NIHAIP Survey Mock-up - NRC Health.pdf		No		Paper Only
Form	2	NIH Outpatient Mock-up -NRC Health	NIHAOP Survey Mock-up - NRC Health.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: 7,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	7,500	0	0	0	0	7,500
Annual IC Time Burden (Hours)	3,750	0	0	0	0	3,750
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Patient Perception Survey fast track	Fast Track Request under GC 0925-0648 CC Patient Perception Surveys.doc	02/14/2018

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