Whistleblower Alternative Dispute Resolution Program Questionnaire

DOL Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0088 can be found here:

Documents and Forms

Document Name Document Type
Screenshots - Employee (12 19 12).pdf www.surveymonkey.com/s/29VQLQB Other-Web-based Survey
Screenshots - Employer (12 19 12).pdf www.surveymonkey.com/s/27ZY5VD Other-Web-based Survey
ADR Survey Draft_Generic_Clearance_Submission_EMPLOYEES 12-7-12.pdf Justification for Whistleblower Mediation Employee Survey IC Document
ADR Survey Draft_Generic_Clearance_Submission_FEDERAL EMPLOYERS REVISED 12-07-12.pdf Justification for Whistleblower Mediation Federal Employer Survey IC Document
ADR Survey Draft_Generic_Clearance_Submission_ STATE-TRIBAL-LOCAL-EMPLOYERS REVISED 12-7-12.pdf Justification for Whistleblower Mediation State, Local, and Tribal Government Employer Survey IC Document
ADR Survey Draft_Generic_Clearance_Submission_PRIVATE EMPLOYERS REVISED 12-7-12.pdf Justification for Whistleblower Mediation Private Sector Employer Survey IC Document
Whistleblower Alternative Dispute Resolution Program Information Email - Employee.pdf Employee Invitation Email IC Document
Whistleblower Alternative Dispute Resolution Program Information Email - Employer.pdf Employer Invitation Email IC Document

Information Collection (IC) Details

IC Title:	Whistleblower Alternative Dispute Resolution Program Questionnaire	Agency IC Tracking Number:

IC Status: New

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
Other-Web-based Survey			Screenshots - Employee (12 19 12).pdf	http://www.surveymonkey.com/s/29VQLQB	Yes	Yes	Fillable Fileable
Other-Web-based Survey			Screenshots - Employer (12 19 12).pdf	http://www.surveymonkey.com/s/27ZY5VD	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 135	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	135	135
Annual IC Time Burden (Hours)	68	68
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Justification for Whistleblower Mediation Employee Survey	ADR Survey Draft_Generic_Clearance_Submission_EMPLOYEES 12-7-12.pdf	01/15/2013
Justification for Whistleblower Mediation Federal Employer Survey	ADR Survey Draft_Generic_Clearance_Submission_FEDERAL EMPLOYERS REVISED 12-07-12.pdf	01/15/2013
Justification for Whistleblower Mediation State, Local, and Tribal Government Employer Survey	ADR Survey Draft_Generic_Clearance_Submission_ STATE-TRIBAL-LOCAL-EMPLOYERS REVISED 12-7-12.pdf	01/15/2013
Justification for Whistleblower Mediation Private Sector Employer Survey	ADR Survey Draft_Generic_Clearance_Submission_PRIVATE EMPLOYERS REVISED 12-7-12.pdf	01/15/2013
Employee Invitation Email	Whistleblower Alternative Dispute Resolution Program Information Email - Employee.pdf	01/15/2013
Employer Invitation Email	Whistleblower Alternative Dispute Resolution Program Information Email - Employer.pdf	01/15/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.