Guidelines-- revised February 2009

U.S. Department of the Interior
Office of Policy Analysis

Guidelines for Accessing the Department of the
Interior’s Generic Clearance for Customer
Satisfaction Surveys

Revised February 2009

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Contents
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1

Guidelines for Accessing the Department of the Interior’s Generic Clearance for Customer Satisfaction Surveys

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Purpose

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2

W hy Do W e Need to Collect Customer Data?

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2

W hat’s Special About the Generic Clearance?

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2

W hat is a Generic Clearance?

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3

DOI’s Programmatic Clearance for Customer Satisfaction Surveys

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4

Types of Questions Covered by the Generic Clearance

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6

How to Use the Clearance
ATTACHMENT 1: Instructions for Completing Supporting Statement for DOI Generic Clearance Submission, OMB
Control Number 1040-0001 ...............................................................................................................

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.................
ATTACHMENT 2: Approval Form for DOI Programmatic Clearance for Customer Satisfaction Surveys

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ATTACHMENT 3: Checklist for Submitting a Request to Use DOI Programmatic Clearance for Customer Satisfaction
Surveys .....................................................................................................................................

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....................................................................................................................................................
ATTACHMENT 4: CERTIFICATION FORM FOR SUBMISSION UNDER OMB CONTROL NUMBER 1040-0001

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Purpose
These guidelines are intended to help Department of the Interior (DOI) offices and bureaus successfully
use the Department’s Programmatic Clearance for Customer Satisfaction Surveys (also known as the
Generic Clearance package) to collect customer satisfaction data. It describes the process, its
requirements, and contains copies of necessary approval forms as attachments.

Why Do We Need to Collect Customer Data?
Interior offices and bureaus must collect customer satisfaction data to comply with the Government
Performance and Results Act (GPRA) of 1993 (P.L. 103-62) and Executive Order (E.O.) 12862.
Additionally, in order to help realize the President’s Management Agenda priorities of creating a
citizen-centered government, the Department of the Interior must measure customer satisfaction levels
associated with its services, products, and information through periodic surveys, face-to-face meetings,
and frequent communication with our customers. Data obtained from these customer interactions can be
used to identify opportunities for improvement. Comment cards, questionnaires, and other survey
methods are viable tools for collecting valuable customer information that can assist DOI’s bureaus and
offices in complying with the Administration’s guidance.

What’s Special About the Generic Clearance?
The Generic Clearance enables DOI offices and bureaus to collect customer information using a
streamlined process for approving the research instruments used in the data collection. The Paperwork
Reduction Act (PRA) of 1995 requires Federal agencies to obtain approval from the Office of
Management and Budget (OMB) before they can collect information from the general public. The PRA
defines “collection of information” quite broadly. It covers any identical questions posed to 10 or more
members of the public, whether voluntary or mandatory, written, electronic, or oral. The term “public”
does apply to State, local and tribal governments. It does not apply to Federal agencies as long as
representatives of Federal agencies are being surveyed as such and not as private citizens.
The standard Paperwork Reduction Act compliance process used by agencies to obtain approval from
OMB to collect customer information typically takes more than 120 days. The Generic Clearance, once
approved, significantly reduces the time needed to obtain OMB approval for use of instruments covered
by the Generic Clearance. Approvals can be obtained in as few as 45 days.

What is a Generic Clearance?
A generic clearance is a master plan for conducting one or more customer surveys. It is prepared using
the standard Paperwork Reduction Act compliance process, which requires at least 120 days from
preparation of the initial draft to final approval by the OMB. Once the generic clearance has been
approved, bureaus and offices can request a quick review of actual details of surveys to be conducted
within the context of the master plan within a significantly reduced timeframe.
The DOI Generic Clearance for Customer Satisfaction Surveys was first approved by OMB in January
2002. Bureaus and offices interested in collecting customer satisfaction data may receive expedited
processing of specific survey instruments, as long as the instruments are consistent with the preapproved “master plan” and provide the required information.

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DOI’s Programmatic Clearance for Customer Satisfaction Surveys
The DOI has received approval from OMB to extend its programmatic (or generic) clearance, OMB
#1040-0001, so that Interior bureaus and offices can conduct customer research using the following
tools:
In-person intercept surveys: In a face-to-face situation, the survey instrument is provided to a
respondent who completes it while on site and then returns it. This may include oral administration or
the use of electronic technology and kiosks. The survey proctor is prepared to answer any questions the
respondent may have about how to fill out the instrument but does not interfere or influence how the
respondents answer the questions.
Telephone interviews or questionnaires: Using existing databases, an interviewer will contact customers
who have had a specific experience with the agency. The interviewer will dial back until the customer
has been reached. Once contacted, the survey respondent is given a brief introduction to the survey,
including its importance and use. The interviewer will then expeditiously move through the survey
questions.
Mail and e-mail surveys: Using existing lists of customer addresses, a three contact-approach based on
Dillman's “Tailored Design Method” will be employed. The first contact is a cover letter explaining
that a survey is coming to them and why it is important to the agency. The second contact will be the
survey instrument itself along with a postage-paid addressed envelope to return the survey. The third
contact will be a reminder postcard sent 10 days after the survey was sent. Finally, the respondents will
receive a letter thanking them for the willingness to participate in the survey and reminding them to
return it if they have not already done so. At each juncture, the respondents will be given multiple ways
to contact someone with questions regarding the survey (including phone, FAX, web, and email). If the
survey has been lost, the respondent can request that another be sent to them. Electronic mail is
sometimes used instead of postal mail to communicate with customers. Although this is a cost-effective
mode to survey a large group of people, it does not usually generate the best response rate. Telephone
calls to non-respondents can be used to increase response rates.
Web-based: For products or services that are provided through electronic means, whether e-commerce
or web-based information, a web or email survey may be most appropriate. During the course of their
web interaction, users can volunteer to add their name to a list of future surveys. From this list, a
respondent pool will be selected in accordance with the sampling procedures outlined above. An email
will be sent to them explaining the need and importance of the survey with a web link to the survey.
Within 5 days, a follow-up email will be sent to the respondents reminding them to complete the
survey. Finally, the respondents will receive an email thanking them for the willingness to participate in
the survey and reminding them to complete it if they have not already. The respondent will always have
the option to submit the survey in paper form, should they elect to do so.
Focus groups: Some data and information are best collected through more subjective, conversational
means. A focus group is an informal, small-group discussion designed to obtain in-depth qualitative
information. Individuals are specifically invited to participate in the discussion, whether in person or
through technologically enhanced means (e.g., video conferencing, on-line sessions). Participants are
encouraged to talk with each other about their experiences, preferences, needs, observations, or
perceptions. A moderator whose role is to foster interaction leads the conversation. The moderator
makes sure that all participants are encouraged to contribute and that no individual dominates the
conversation. Furthermore, the moderator manages the discussion to make sure it does not stray too far
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from the topic of interest. Focus groups are most useful in an exploratory stage or when the
bureau/office wants to develop a deeper understanding of a program or service.
Using the best in focus group research practices, groups will be constructed to include a cross-section of
a given customer group. The questions and additional probes used during the focus groups will be
consistent with the “guideline menu.”
Comment Cards: Comment cards, when provided to a customer at the time a product or service is
provided, offer an excellent means to give the bureaus and offices feedback. A comment card should
have a limited number of questions and an opportunity to comment. These comment cards provide
managers and service providers with direct and specific information from their customers that could not
be obtained through any other means.
Electronic users may be offered the opportunity to complete a comment card via a “pop-up” window (or
other web-enabled means that may be available). The “pop-up” window will not appear for every user;
rather, the users will be selected randomly to receive the survey. This practice is widely used in private
industry. In other instances, the electronic user may be offered the option to self-select in answering the
electronic comment card.
Whether using paper or electronic comment cards, the intent is to provide a feedback mechanism. The
data are not intended to be statistically significant. Although questions may include numeric scales,
those data should be considered only in an anecdotal fashion and not reported as a significant measure.

OMB Guidance on Survey Design
All surveys must be designed and implemented in accordance with OMB "Guidance on Agency Survey
and Statistical Information Collections (January 20, 2006)." The OMB guidance document, entitled
"Questions And Answers When Designing Surveys For Information Collections," can be obtained from
the OMB web site at the following link:
http://www.whitehouse.gov/omb/inforeg/statpolicy.html

Types of Questions Covered by the Generic Clearance
The DOI Generic Clearance was approved for customer satisfaction surveys. Therefore, survey
instruments that will be approved under the authority of the generic clearance must focus on customer
satisfaction data. It is important to note that NO INFORMATION COLLECTION
INSTRUMENTS SEEKING TO COLLECT INFORMATION BEYOND THE SCOPE OF
CUSTOMER SATISFACTION DATA WILL BE CONSIDERED UNDER THE SCOPE OF
THIS PROGRAMMATIC CLEARANCE. This includes information collections designed to
obtain social science or visitor use information.
To be considered under the scope of this Programmatic Clearance, information collection instruments
are restricted to the following topic areas. Although no one survey will cover all the topic areas, these
should be viewed as a “guideline menu” from which bureaus and offices will develop their survey
questions.
1. Delivery, quality and value of products, information, and services :
The range of questions envisioned for this topic area will focus on customer satisfaction with aspects

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of information, products, and related services offered by DOI. Information, products, and services
include written reports, press releases, computer modules, workshops and seminars, or technical
assistance. Respondents may be asked for feedback regarding the following attributes of the
information, service, and products provided:
·
·
·
·
·
·
·
·

Timeliness (Was the information, service, product provided to you in a timely manner?)
(Was the information itself timely?)
Consistency (Was the quality of the service consistent with your expectations?)
Accuracy (Were the data provided accurate?)
Ease of Use and Usefulness (Was the product easy to use? Was the information useful to
you?)
Ease of Information Access (Were you able to find the information you needed easily?)
Helpfulness (Was the information helpful?)
Quality (Was the information of high quality?)
Value for fee paid for information/product/service (Was the cost of the product, information
or service appropriate for the value?)

2. Management practices:
This area covers questions relating to how well customers are satisfied with Interior management
practices and processes, what improvements they might make to specific processes, and whether or
not they feel specific issues were addressed and reconciled in a timely, courteous, responsive
manner. Questions within this area may involve feedback regarding how well Interior engaged
customers on a specific topic. They may also seek opinions from customers regarding how well
Interior programs are managing and administering specific processes (for example, the Bureau of
Land Management may ask customers how well it is administering its permitting processes.)
3. Mission management:
Questions will ask customers and partners to provide satisfaction data related to Interior’s ability to
protect, conserve, provide access to, provide scientific data about, and preserve natural, cultural, and
recreational resources that we manage, and how well we are carrying out our trust responsibilities to
American Indians, Native Alaskans, and Insular Areas. Questions will specifically ask customers
and partners to provide satisfaction data related to each of its four mission areas as described in its
GPRA Strategic Plan: Resource Use, Resource Protection, Serving Communities, and Recreation.
4. Rules, regulations, policies:
This area focuses on obtaining feedback from customers regarding fairness, adequacy, and
consistency in enforcing rules, regulations, and policies for which Interior is responsible. It will also
help us understand public awareness of rules and regulations and whether or not they are articulated
in a clear and understandable manner. It will not seek opinions from customers regarding the
appropriateness of regulatory rulings themselves.
5. Interactions with DOI Personnel and Contractors:
Questions developed under this topic area will focus on obtaining customer feedback regarding
attributes of interactions with Interior office and bureau employees, as well as Interior contractors.
Attribute questions will range from timeliness and quality of interactions to skill level of staff
providing the assistance, as well as their courtesy and responsiveness during the interaction.
6. General demographics:

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Some general demographics may be gathered to augment satisfaction questions in order to better
understand the customer so that we can improve how we serve that customer. Demographics data
will range from asking customers how many times they have used an Interior service or visited an
Interior facility within a specific timeframe, to their ethnic group and race. Sensitivity and prudence
will be used in developing and deploying questions under this topic area so that the customer does
not perceive an intrusion upon his/her privacy. Additionally, these questions will only be asked as
long as the data are critical to understanding customer satisfaction and the character of the customer
base. Demographics may also be used as part of a non-response bias strategy to ensure responses
are representative of the contact universe.

How to Use the Clearance
To use the Clearance authority, bureaus and offices must ensure that the survey instrument is consistent
with the intent of the generic clearance; i.e., that the instruments focus on obtaining customer
satisfaction data. Bureaus and offices must prepare an approval package and submit an electronic copy
of that package in Word format to a qualified statistician for preliminary review and approval. Some
.pdf files of survey instruments may be accepted. Each package must have the name, telephone number,
and e-mail address of the statistician who reviewed and approved the package, along with the dates of
his/her review and approval. Next the reviewed package must be approved by the bureau or office
Information Collection Clearance Officer. Each package must have the name, telephone number, and email address of the Information Collection Clearance Officer who reviewed and approved the package,
along with the dates of his/her review and approval. The reviewed and approved package may then be
submitted to the Office of Policy Analysis.
Each package must include the following:
¨ A copy of the entire survey instrument;
¨ A completed Supporting Statement (see attachments 1 and 2);
¨ A Certification Form containing contact information of reviewers and dates of respective reviews
and approvals (see attachment 4);
¨ Other supporting materials, including cover letters, introductory scripts (primarily for focus groups)
and follow-up letters (aimed at encouraging response).
Important: One electronic copy of the entire package, containing each of the above components, must
be provided to the Office of Policy Analysis, along with certification that the required reviews and
approvals have been obtained, before we can process the request. Deviation from these guidelines will
result in the package being returned to the requesting office/bureau for completion of missing
components.

I. Timelines for Requesting Approvals
The request for approval under the Generic Clearance and submission of a complete and accurate
approval package should be made to DOI at least 45 calendar days prior to the first day the
bureau/office plans to administer the survey instrument to the public.
The Office of Policy Analysis will provide an administrative and technical review of the submitted
materials and notify the requesting bureau/office of the results. The Office of Policy Analysis will work
with the bureau/office to make any necessary revisions before submitting the package to OMB for
approval. Once OMB approves the instrument, the bureau/office will be notified. No survey

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instruments may be administered until OMB approval is received.

II. Request and Approval Process Steps
The steps in the Generic Clearance approval process include the following:
Step 1:
The requesting bureau/office completes the Supporting Statement (attachment 2) and the Certification
Form (attachment 4). Instructions are provided for each item on the form (attachment 1).
Step 2
The bureau/office submits a copy of the entire approval package to a qualified statistician for review and
approval of the instrument and survey methodology. The package must include:
(a) the completed Supporting Statement (attachment 2);
(b) completed Certification Form (attachment 4);
(c) any introductory script used in contacting the public;
(d) all cover letters, postcard reminders or follow-up letters to be sent to potential respondents;
(e) the entire survey instrument;
(f) necessary Paperwork Reduction Act (PRA) compliance language inserted into the survey instrument;
and
(g) any other supporting materials.
For face-to-face information collections, such as interviews and focus groups, a short statement
describing how the bureau/office intends to communicate PRA compliance information to respondents
is required in the description of the survey methodology (required as part of the Supporting Statement).
The statistical review must be performed on the complete package to be acceptable.
Step 3
The bureau/office submits a copy of the entire approval package, including a Certification Form noting
the date of the statistical review and approval, to the bureau/office Information Collection Officer. The
package must include elements a-g as described in Step 2 above.
Step 4
Once both a qualified statistician and the bureau/office Information Collection Clearance Officer have
reviewed and approved the package, it may be submitted to the Office of Policy Analysis (PPA). The
entire package should be submitted electronically and be formatted in Word. .pdf files of some
information collection instruments may be accepted in lieu of Word.
Step 5
PPA assigns a certification tracking number and confirms receipt of the package with an email to the
bureau/office point of contact.
Step 6
PPA staff members conduct an administrative and technical review of the submission. The staff
recommends (a) approval, (b) revision, (c) resubmission under the Standard Paperwork Reduction Act
approval process, or (d) rejection of the proposed survey. If the package is not approved, PPA will
notify the originating office/bureau and coordinate revision and resubmission.

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Step 7
Once approved, PPA staff transmits the package to OMB for final approval.
Step 8
OMB reviews the submission and notifies PPA of approval or necessary revisions.
Step 9
Once approved by OMB, PPA notifies the requesting bureau/office and assigns an OMB number, a
unique PPA identification number, and an expiration date. If OMB requires any special conditions to
the approval, the requesting bureau/office will be informed and the conditions must be met for approval.
Should OMB reject the submission or have specific questions about the survey instrument, PPA will
immediately inform the requesting bureau/office. The bureau/office may submit an appeal of the OMB
decision to PPA, in writing. PPA will submit the appeal to OMB and inform the bureau/office of the
results.
Step 10
The bureau/office prepares a final survey instrument, submitting an archive copy to PPA.
The final survey instrument must include the following: (a) the OMB number, (b) the unique PPA
identification number, (c) the expiration date, and (d) the Paperwork Reduction Act compliance
statement.
Additions or changes to a survey instrument after it has been approved, even within the specific topic
areas, are not allowed by OMB. An exception is that questions may be deleted after approval by OMB,
if necessary.
Step 11
The bureau/office submits a copy of the survey report to PPA (see requirements for Reporting Plan at
Question #15 on Supporting Statement) for archiving.

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ATTACHMENT 1: Instructions for Completing Supporting Statement for

DOI Generic Clearance Submission, OMB Approval Number 1040-0001
1. Survey Title/Date Submitted to the Office of Policy Analysis (PPA): Insert title for the proposed
survey. Insert date that the expedited approval package will be submitted to PPA. Reminder:
Please submit the package through your bureau/office Information Collection Clearance Officer.
2. Bureau/Office: Insert the name of the bureau/office conducting the survey.
3. Abstract: Summarize the proposed study with an abstract not to exceed 150 words.
4. Bureau/Office Point of Contact Information: Complete the bureau/office contact information.
PPA will communicate with the point of contact listed here throughout the entire approval process.
5. Principal Investigator (PI) Conducting the Survey: Complete information about the PI who will
be conducting the survey, if different than Point of Contact listed in #4. Otherwise note: Same as
#4.
6. Name of Program Office Conducting Survey: Provide the name of the bureau program, office, or
organizational unit conducting the survey.
7. Description of Customers/Services Provided: Provide a brief description of the customers who
will be surveyed, the services provided by the program conducting the survey, and how these
services are provided to customers.
8. Survey Dates: List the time period in which the survey will be conducted, including specific
starting and ending dates. The starting date should be at least 45 days after the submission date.
The request for expedited approval, and submission of a complete and accurate approval package,
must be made at least 45 calendar days prior to the first day the PI wishes to administer the survey
instrument to the public.
9. Type of Information Collection Instrument: Check the type(s) of information collection
instrument(s) that will be used. If other, please explain.
10. Survey Development: Explain how the survey was developed. With whom did you consult during
the development of the survey on content? On statistics? Did you pretest the survey? What actions
did you take to improve the survey? What suggestions did you receive for improving the survey?
Which of the six topic areas will be addressed? (Note: A description of any pre-testing and peer
review of the methods and/or instrument is highly recommended.)
11. Survey Methodology: Explain how the survey will be conducted. Provide a description of the
survey methodology including: (a) How will the customers be sampled? (if fewer than all customers
will be surveyed); (b) What percentage of customers asked to take the survey will respond, and (c)
What actions are planned to increase the response rate? If statistics are generated, this description
must be specific and include each of the following:
- The respondent universe,
- The sampling plan and all sampling procedures, including how individual respondents will be
selected;
- How the instrument will be administered;
- Expected response rate and confidence levels; and
- Strategies for dealing with potential non-response bias.
Note: Web-based surveys are not an acceptable method of sampling a broad population. Web-based
surveys must be limited to services provided by the web.
12. Total Number of Initial Contacts/Expected Number of Respondents: Provide an estimated total

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number of initial contacts and the total number of expected respondents.
13. Estimated Time to Complete Initial Contact/Instrument: Estimate the time to complete the
initial contact and the survey instrument (in minutes).
14. Total Burden Hours: Provide the total number of burden hours. The total burden hours should
account for the amount of time required to instruct the respondents in completing the survey, and the
amount of time required for the respondent to complete the survey.
15. Reporting Plan: Provide a brief description of the reporting plan for the data being collected. A
copy of all survey reports must be archived with PPA. Please note this in the reporting plan.
16. Justification, Purpose and Use: Provide a brief justification for the survey, its purpose, goals, and
utility to managers. Specifically, describe how data will be tabulated and what statistical techniques will
be used to generalize the results to the entire customer population. Describe how data from the survey
will be used. Describe how you will acknowledge any limitations related to the data, particularly in
cases where we obtain a lower than anticipated response rate. Note whether or not the survey is
intended to measure a Government Performance and Results Act (GPRA) performance measure.

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10. ATTACHMENT 2: Approval Form for DOI Programmatic Clearance for

Customer Satisfaction Surveys (OMB Control Number 1040-0001)
U.S. Department of the Interior

PPA Tracking Number: (for PPA use only)

Office of Policy Analysis (PPA)
1.
2.

Survey Title:

Date Submitted to PPA:

Bureau:

Abstract:
3.

(not to exceed 150 words)

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4. Bureau/Office Point of Contact Information
First Name:

Last
Name:

Title:
Bureau/Office
:
Street
Address:
City:

State
:

Phone:

Fax:

Zip
code:

Email:
5.

Principal Investigator (PI) Information
First Name:

Last
Name:

Title:
Bureau/Office
:
Address:

City:

State:

Phone:

Fax:

Email:

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Zip:

6. Name of
Program or
Office
Conducting
Survey:
7. Description of
Customers/
Services
Provided:
8. Survey Dates:
(mm/dd/yyyy)

to

(mm/dd/yyyy)

9. Type of Information Collection Instrument (Check ALL that Apply)
__Intercept
__Telephone
__Mail
__Web-based

__Focus
Groups

__Comment Cards
__Other, Explain:
10. Survey
Development:
(Who assisted in
survey content
development
Statistics? Was
the survey
pretested? How
were
improvements
integrated?
Which of the six
topic areas will
be addressed?)

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11.Survey
(a) Respondent universe:
Methodology:
(Use as much
space as needed; if
necessary include
(b) Sampling plan/procedures:
additional
explanation on
separate page.)
(c) Instrument administration:

(d) Expected response rate/confidence levels:

(e) Strategies for dealing with potential non-response bias:
(f) Description of any pre-testing and peer review of the methods and/or
instrument (recommended):

12. Total Number of
Initial Contacts/
Expected
Number of
Respondents:

15.

14

Reporting Plan:

13.

Estimated Time
to Complete
Initial Contact |
Instrument
(mins.):

14.

Total
Burden
Hours:

16. Justification, Purpose, and Use:

Survey Justification and Purpose:

Survey Goals:

Utility to Managers:

How will the results of the survey be analyzed and used?

How will the data be tabulated? What Statistical Techniques will be used to generalize the
results to the entire customer population? How will limitations on use of data be handled?
If the survey results in a lower than anticipated response rate, how will you address this
when reporting the results?

Is this survey intended to measure a Government Performance and Results Act (GPRA)
performance measure? If so, please include an excerpt from the appropriate document.

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ATTACHMENT 3: Checklist for Submitting a Request to Use DOI Programmatic
Clearance for Customer Satisfaction Surveys
o All questions in the survey instrument are within the scope of one of the DOI
Programmatic Clearance for Customer Satisfaction Surveys topic areas.
o The approval package is being submitted to the Office of Policy Analysis at
least 45 days prior to the first day the PI wishes to administer the survey to
the public.
o A qualified statistician has reviewed and approved your request.
o Your bureau/office Information Collection Clearance Officer has reviewed
and approved the approval package.
The approval package includes:
a completed Information Form
o
a signed Certification Form
o
a copy of the survey instrument
o
other supporting materials, such as
o
cover letters to accompany mail-back questionnaires
o
introductory scripts for initial contact of respondents
o
necessary Paperwork Reduction Act compliance language
o
follow-up letters/reminders sent to respondents
o
The survey methodology presented on the Information Form includes a specific
description of:
(a) the respondent universe
o
(b) the sampling plan and all sampling procedures, including how
o
respondents will be selected
(c) how the instrument will be administered
o
(d) expected response rate and confidence levels
o
(e) strategies for dealing with potential non-response bias
o
(f) a description of any pre-testing and peer review of the methods and/or the
o
instrument is highly recommended.
o

o

The burden hours reported on the Information Form include the number of
burden hours associated with the initial contact of all individuals in the
sample (i.e., including refusals), if applicable, and the number of burden
hours associated with individuals expected to complete the survey
instrument.
The package is properly formatted (Word) and submitted to the Office of
Policy Analysis electronically.

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ATTACHMENT 4: CERTIFICATION FORM FOR SUBMISSION UNDER OMB
CONTROL NUMBER 1040-0001
This form should only be used if you are submitting a collection of information for
approval under the DOI Programmatic Clearance for Customer Satisfaction
Surveys.
If the collection does not satisfy the requirements of the Programmatic Clearance, you
should follow the regular PRA clearance procedures described in 5 CFR 1320.
Bureau/Office Subgroup or Program:
Title (Please be specific):
Burden Hour Estimates
No. of Respondents:

Hours/Min Per Response:

Total Burden Hours:

Bureau/Office Contact (who can best answer questions about content of the submission):
Name:
Phone:
Certification: The collection of information requested by this submission meets the
requirements of OMB control number 1040-0001.
________________________________________________________________________
Bureau/Office Qualified Statistician
DATE

Bureau/Office Information Collection Clearance Officer

DATE

Office of Policy Analysis

DATE

OMB, Office of Information and Regulatory Affairs (OIRA)

DATE

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