Information Collection

Evaluation of Mediation Services (Participant) - IC for State, Local and Tribal Govt. Respondents

IC 185871 under ICR 201012-3320-001 · OMB 3320-0004.

Documents and Forms

Document Name Document Type
Form 3320 0004(1) Evaluation of Mediation Services (Participant) - IC for State, Local and Tribal Govt. Respondents Form and Instruction
3320 0004(1) Mediation Services Participant Questionnaire Rev 2012 Mediation Services Participant Questionnaire _Rev 2012_.pdf Note: Electronic version currently being finalized Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of Mediation Services (Participant) - IC for State, Local and Tribal Govt. Respondents	Agency IC Tracking Number:	0004b

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3320 0004(1)	Mediation Services Participant Questionnaire Rev 2012	Mediation Services Participant Questionnaire _Rev 2012_.pdf	Note: Electronic version currently being finalized	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	500	-100	600
Annual IC Time Burden (Hours)	150	-50	200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.