Information Collection

Customer Survey - Ind / Households

IC 43726 under ICR 201008-0970-001 · OMB 0970-0303.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0970-0303 Customer Survey - Ind / Households	Form
0970-0303 Appendix B_Customer Survey Appendix B_Customer Survey.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	0970-0303	Appendix B_Customer Survey	Appendix B_Customer Survey.doc		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 846

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 76 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	846	-362	1,208
Annual IC Time Burden (Hours)	66	-28	94
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.