Information Collection

Evaluation of Roster Program (Roster Member) - IC for State, Local and Tribal Govt. Respondents

IC 185858 under ICR 201012-3320-007 · OMB 3320-0005.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3320-0005(2) Evaluation of Roster Program (Roster Member) - IC for State, Local and Tribal Govt. Respondents	Form and Instruction
3320-0005(2) Roster Services - Member Questionnaire (Rev 2012) Roster Services Member Questionnaire _Rev 2012.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0005b RMs

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	3320-0005(2)	Roster Services - Member Questionnaire (Rev 2012)	Roster Services Member Questionnaire _Rev 2012.pdf		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: 5

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	-5	10
Annual IC Time Burden (Hours)	0	-1	1
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.