RACE/ETHNIC QUESTIONNAIRE, CUSTOMER OPINION SURVEY

ICR 199409-0960-002

OMB: 0960-0535

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
115723 Migrated
ICR Details
0960-0535 199409-0960-002
Historical Active
SSA
RACE/ETHNIC QUESTIONNAIRE, CUSTOMER OPINION SURVEY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/11/1994
Retrieve Notice of Action (NOA) 09/12/1994
  Inventory as of this Action Requested Previously Approved
09/30/1995 09/30/1995
4,500 0 0
375 0 0
0 0 0

THE INFORMATION COLLECTED BY THESE FORMS IS USED FOR PROGRAM EVALUATIONS. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS WHO FILE FOR TITLE II BENEFITS.

None
None


No

1
IC Title Form No. Form Name
RACE/ETHNIC QUESTIONNAIRE, CUSTOMER OPINION SURVEY SSA-137, SSA-138

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,500 0 0 4,500 0 0
Annual Time Burden (Hours) 375 0 0 375 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/12/1994


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