Technical Assistance Evaluation

Technical Assistance Evaluation

OMB # 1029-0114

Expires 2/29/2008

Recently the OSM’s (Fill in organization) provided technical assistance for the project or activity listed below. OSM would appreciate you taking the time to complete this evaluation. Your response will assist us in evaluating and improve our performance. We are collecting this information as a part of evaluating OSM’s performance of its responsibilities under the Government Performance and Results Act.

Project Name:

Assistance completed on:

Assistance provided by:

Type of assistance: []Permitting []Inspection []Enforcement []Other (describe)

Was the assistance timely? Yes/No

Comments:

Was the assistance of high quality and professional? Yes/No

Comments:

Were your objectives for the assistance met? Yes/No

Comments:

(Please circle one)

How would you rate the quality of assistance: (Poor) 1 2 3 4 5 (Excellent)

Comments:

Please return to: Office of Surface Mining Or fax to (organization fax)

(organization address) or send by email to @osmre.gov

(organization city)

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.