Information Collection

Whistleblower Alternative Dispute Resolution Program Questionnaire

IC 205418 under ICR 201104-1225-001 · OMB 1225-0088.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Whistleblower Alternative Dispute Resolution Program Questionnaire

Agency IC Tracking Number:

IC Status: New

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.