Information Collection

Evaluation of Assessments (Initiator) - IC for Individual or Household Respondents

IC 185868 under ICR 201012-3320-004 · OMB 3320-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3320-0003 can be found here:

Documents and Forms

Document Name Document Type
Form 3320-0003(1) Evaluation of Assessments (Initiator) - IC for Individual or Household Respondents Form and Instruction
3320-0003(1) Assessment Services Requester Questionnaire (Rev 2011) Assessment Services Requester Questionnaire (Rev 2011).pdf Note: Electronic version of instrument currently being finalized Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of Assessments (Initiator) - IC for Individual or Household Respondents	Agency IC Tracking Number:	0003d

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	3320-0003(1)	Assessment Services Requester Questionnaire (Rev 2011)	Assessment Services Requester Questionnaire (Rev 2011).pdf	Note: Electronic version of instrument 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: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	75	-25	100
Annual IC Time Burden (Hours)	6	-4	10
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.