Information Collection

User Fees Customer Survey

IC 197956 under ICR 201106-0910-001 · OMB 0910-0360.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0360 can be found here:

Documents and Forms

Document Name Document Type
User Fees Customer Survey.doc REv. 06-07-2011.doc Other-Survey
Justification Memo - User Fees Customer Survey.doc Justification Memo - User Fees Customer Survey IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	User Fees Customer Survey	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-Survey			User Fees Customer Survey.doc REv. 06-07-2011.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	300	0	0	0	0	0
Annual IC Time Burden (Hours)	10	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Justification Memo - User Fees Customer Survey	Justification Memo - User Fees Customer Survey.doc	04/08/2011

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