Information Collection

Mail Survey

IC 181688 under ICR 200708-0970-005 · OMB 0970-0331.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Mail Survey	Form and Instruction
1 Mail Survey Mail survey.instrument.AppA.pdf	Form and Instruction
Mail survey.instrument.AppA.pdf Mail Survey Instrument	IC Document

IC Title:

Mail Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Mail Survey	Mail survey.instrument.AppA.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: Survivor Compensation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mail Survey Instrument	Mail survey.instrument.AppA.pdf	11/08/2007

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