Information Collection

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

IC 206434 under ICR 201109-2125-001 · OMB 2125-0628.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2125-0628 can be found here:

Documents and Forms

Document Name Document Type
TIM_PSE Survey.docx Other-Cust Satisfaction Survey
TIM_PSE Fast Track Form.docx Traffic Incident Management (TIM)/Planned Special Event (PSE) Conference Customer Feedback IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery	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-Cust Satisfaction Survey			TIM_PSE Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Transportation

Subfunction: Ground Transportation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Traffic Incident Management (TIM)/Planned Special Event (PSE) Conference Â Customer Feedback	TIM_PSE Fast Track Form.docx	04/10/2013

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