Technical Transfer Evaluation

TECHNICAL TRANSFER EVALUATION

OMB # 1029-0114

Expires 2/29/2008

The OSM’s (Name of organization) recently provided a technical transfer project or activity as listed below. In order to better provide technical transfer activities in the future, we would appreciate your input by completing this form. We are collecting this information as part of evaluating OSM’s performance of its responsibilities under the Government Performance and Results Act.

Project Name __________________________________________________________________

Technical transfer completion date ________________ Project ID # ________

Type of Transfer

Workshop [ ] Presentation [ ]

Document Request [ ] Consultation [ ]

Other [ ] Please describe __________________________________

Please rate your overall level of satisfaction with the technical transfer activity.

(Please circle one)

(very dissatisfied) 1 2 3 4 5 (very satisfied)

Comments

Your Name ___________________________ Date ________________

Return to: Office of Surface Mining or Fax to: (organization’s fax)

(Organization name) or e-mail to @osmre.gov

(Organization address)

PAPERWORK REDUCTION STATEMENT

The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to inform you that: Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. This information is being collected in order to better serve you in the future and as part of OSM's performance of its responsibilities under the Government Performance and Results Act. The obligation to respond is voluntary.

Public reporting burden for this form is estimated to average 5 minutes per response, including time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, Room 202 SIB, 1951 Constitution Ave, NW, Washington, D.C. 20240.