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

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0004b

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 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 %

table that charts list of burden
	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

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.