CFI 180 HHS OCS Assets for Independence, CFI 181 State BCA Passport Services

American Customer Satisfaction Index

Documents and Forms

Document Name Document Type
Form CFI 180 CFI 180 HHS OCS Assets for Independence, CFI 181 State BCA Passport Services Form
CFI 180 HHS OCS Assets for Independence questionnaire CFI 180 HHS OCS Assets for Independence.doc Form
CFI 181 State BCA Passport Services questionnaire CFI 181 State BCA Passport Services.doc Form

Information Collection (IC) Details

IC Title:	CFI 180 HHS OCS Assets for Independence, CFI 181 State BCA Passport Services	Agency IC Tracking Number:	CFI 180, CFI 181

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CFI 180	HHS OCS Assets for Independence questionnaire	CFI 180 HHS OCS Assets for Independence.doc		Yes	Yes	Fillable Fileable
Form	CFI 181	State BCA Passport Services questionnaire	CFI 181 State BCA Passport Services.doc		No		Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 520	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	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	520	0	0	0	0	0
Annual IC Time Burden (Hours)	104	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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