Information Collection

Previously Cleared ICs from prior Generic ICR

IC 199748 under ICR 201110-1090-001 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA e-Benefits Previously Cleared ICs from prior Generic ICR	Form and Instruction
398 CQs 398 CQs 2011 398 CQs for OMB 12-14-2010 to 1-11-2011.xlsx	Form and Instruction
399 NIDCR 399 NIDCR English 2011 2011 399 NIDCR English 2011 Questionnaire.xlsx	Form and Instruction
400 NGS NOAA 400 NGS NOAA 2011 400 Questionnaire_NGSNOAA_12-16-2010.xlsx	Form and Instruction
401 CDC 401 CDC 2011 401 CDC_New_Questionnaire_12_27_2010_FINAL3.xlsx	Form and Instruction
404 VOA 404 VOA 2011 404 VOA English V2 Questionnaire _Template.xls	Form and Instruction
405 CQs 1-11-11 405 CQs 1-11-11 2011 405 CQs for OMB 1-11-2011 to xxxx.xlsx	Form and Instruction
406 GSA 406 GSA Auctions 2011 406 GSA Auctions FINAL 1-12-11.xls	Form and Instruction
407 GSA 407 GSA Xcess 2011 407 GSA Xcess FINAL 1-7-11.xls	Form and Instruction
408 RegInfo 408 RegInfo 2011 408 Questionnaire RegInfo v2.xlsx	Form and Instruction
414 ePSS 414 ePSS Wave 1 2011 414 ePSS Questionnaire Wave 1 Revised.xlsx	Form and Instruction
415 FCIC 415 FCIC Cons Action CQs 2011 415 FCIC Consumer Action CQ revisions_11Feb2011.xlsx	Form and Instruction
416 FCIC 416 FCIC Pueblo 2011 416 FCIC Pueblo Survey revisions_11Feb2011.xlsx	Form and Instruction
417 HowTo 417 HowTo 2011 417 Howto.gov Survey 3.7.2011 - current.xlsx	Form and Instruction
418 NLM 418 NLM Clinical Trials 2011 418 NLM Clinical Trials Questionnaire _2-14-11.xls	Form and Instruction
419 CMS 419 CMS Palmetto GBA J11 MAC 2011 419 CMS Palmetto GBA J11 MAC Questionnaire 3-10-11.xlsx	Form and Instruction
420 CQs 420 CQs 2-4-11 2011 420 CQs for OMB 2-4-2011 to 3-25-11.xlsx	Form and Instruction
421 DHHS PSC 421 DHHS PSC Offline 2011 421 DHHS-PSC Offline Services Questionnaire 02-25-11.xlsx	Form and Instruction
422 DOT 422 DOT FHWA 2011 422 DOT FHWA Questionnaire 02-17-2011.xlsx	Form and Instruction
423 DOJ 423 DOJ COPS Pub Mo 2011 423 DOJ COPS Publication MonthlySurvey FY2011 UPDATED 3_18.docx	Form and Instruction
424 AHRQ 424 AHRQ Eff Health Care 2011 424 AHRQ Effective Health Care.xlsx	Form and Instruction
425 FEMA 425 FEMA Mobile 2011 425 FEMA Mobile Survey Final 2.28.11.xlsx	Form and Instruction
426 NIST 426 NIST Sat v 3-28-11 2011 426 NIST Sat Survey v2 03-28-11.xlsx	Form and Instruction
427 CQs 427 CQs 3-25-11 2011 427 CQs for OMB 3-25-2011 to 4-8-2011.xlsx	Form and Instruction
431 CQs 431 CQs 4-8-11 2011 431 CQs for OMB 4-8-2011 to 4-28-2011.xlsx	Form and Instruction
432 FEMA 432 FEMA ReadyGov 2011 432 FEMA Readygov_Template_4.13.11.xls	Form and Instruction
433 BenefitsGov 433 BenefitsGov 2011 433 Benefits.gov.xlsx	Form and Instruction
439 FMCSA 439 FMCSA Passenger Carrier 2011 439 FMCSA Passenger Carrier Satisfaction Survey.xlsx	Form and Instruction
440 FMCSA 440 FMCSA Protect Your Move 2011 440 FMCSA Protect Your Move Satisfaction Survey V2.xlsx	Form and Instruction
441 FMCSA 441 FMCSA v2 2011 441 FMCSA Satisfaction Survey v2.xlsx	Form and Instruction
443 CQs 443 CQs 4-28-11 2011 443 CQs for OMB started 4-28-2011.xlsx	Form and Instruction
457 CQs 457 CQs 5-17-11 2011 457 CQs for OMB started 5-17-2011.xlsx	Form and Instruction
458 NICHD 458 NICHD 2011 458 NICHD Survey.xlsx	Form and Instruction
459 US Courts 459 US Courts 2011 459 US Courts Survey.xlsx	Form and Instruction
460 US Embassies 460 US Embassies Enterprise 2011 460 US Embassies Enterprise Survey.xlsx	Form and Instruction
461 CMS 461 CMS Medicare Plan Finder 2011 461 CMS Medicare Plan Finder.xlsx	Form and Instruction
462 CQs 462 CQs 6-14-11 2011 462 CQs for OMB started 6-14-2011.xlsx	Form and Instruction
463 DoD 463 Dod Enterprise 2011 463 DoD Enterprise Measure Questionnaire.xlsx	Form and Instruction
471 Health IT 471 Health IT 2011 471 Copy of HealthIT+qnaire+for+dataload+final.xlsx	Form and Instruction
472 CQs 472 CQs 7-8-11 2011 472 CQs for OMB started 7-8-2011.xlsx	Form and Instruction
473 SSA 473 SSA iClaim v2 2011 473 SSA iClaim v2.xlsx	Form and Instruction
478 FSIS 478 FSIS Intranet 2011 478 FSIS Intranet Questionnaire_8-9-11.xls	Form and Instruction
479 CQs 479 CQs 7-26-11 2011 479 CQs for OMB started 7-26-2011.xlsx	Form and Instruction
481 FBI 481 FBI v3 2011 481 FBI V3 Questionnaire.xlsx	Form and Instruction
483 CQs 483 CQs 9-15-11 2011 483 CQs for OMB started 9-15-2011.xlsx	Form and Instruction
484 Healthfinder 484 Healthfinder v2 2011 484 Healthfinder -V2 - October 2011.xlsx	Form and Instruction
485 NIAID 485 NIAID 2011 485 NIAID October 2011.xlsx	Form and Instruction
486 PBGC 486 PBGC v3 2011 486 PBGC.gov V3.xlsx	Form and Instruction
487 SSA 487 SSA Extra Help v2 Eng Equiv 2011 487 SSA Extra Help V2 (English Eqiv).xlsx	Form and Instruction
394 DHS CIS 394 DHS CIS Citizenship Resource Center 2010 394 DHS CIS Citizenship Resource Center 11-18-10FINAL.xls	Form and Instruction
393 CQs 393 CQs 11-29-10 2010 393 CQs for OMB 11-29-2010 to 12-14-2010.xlsx	Form and Instruction
392 USTTB CQs 392 USTTB CQs 2010 392 USTTB Custom Questions 11.29.10 v2.xlsx	Form and Instruction
387 CQs 387 CQs 11-3-10 2010 387 CQs for OMB 11-3-2010 to 11-29-2010.xlsx	Form and Instruction
386 DOJ 386 DOJ BJS 2010 386 DOJ - BJS Questionnaire.xls	Form and Instruction
385 CVC 385 CVC 2010 385 Capitol Visitor CenterQuestionnaire.xlsx	Form and Instruction
384 PSC 384 DHHS PSC 2010 384 PSC Questionnaire Draft customer approved.xlsx	Form and Instruction
383 FedsHireVets 383 OPM FedsHireVets 2010 383 FedsHireVets FINAL Questionnaire 110810.xls	Form and Instruction
382 FCA 382 FCA 2010 382 FCA Draft Questionnaire.xls	Form and Instruction
378 CQs 378 CQs 10-17-10 2010 378 CQs for OMB 10-17-2010 to 11-3-2010.xlsx	Form and Instruction
377 USPTO 377 USPTO Revised 2010 377 Qnaire_USPTO_October_CB_Revised.xls	Form and Instruction
373 CQs 373 CQs 9-21-10 2010 373 CQs for OMB 9-21-2010 to 10-17-2010.xlsx	Form and Instruction
372 PBGC 372 PBGC My PAA v3 2010 372 PBGC My PAA v3 Questionnaire 10-4-2010.xlsx	Form and Instruction
371 NLM 371 NLM Exhibition 2010 371 NLM Exhibition Survey Template_9_10.xlsx	Form and Instruction
370 MyMoney 370 MyMoney 2010 370 MyMoney gov Questionnaire Template 9-17-10FINAL.xls	Form and Instruction
369 GobiernoUSA 369 GobiernoUSA 2010 369 GobiernoUSA Questionnaire 9 28 10.xlsx	Form and Instruction
366 CQs 366 CQs 8-25-10 2010 366 CQs for OMB 8-25-2010 to 9-21-2010.xlsx	Form and Instruction
365 CPSC 365 CPSC 2010 365 CPSC.gov Questionnaire 8-24-2010.xlsx	Form and Instruction
364 RE and S-RE 364 RE and S-RE 2010 364 Survey Final - RE and S-RE, August 2010.xls	Form and Instruction
363 NIH 363 NIH NIDCD 2010 363 NIH NIDCD.xlsx	Form and Instruction
362 Medicare 362 Medicare 2010 362 Final Questionnaire_Medicare.gov_09.07.2010.xls	Form and Instruction
350 FDA 350 FDA 8-11-10 2010 350 FDA Email Model - 8.11.10 FINAL.xlsx	Form and Instruction
349 CQs 349 CQs 8-9-10 2010 349 CQs for OMB 8-9-2010 to 8-25-2010.xlsx	Form and Instruction
348 CPSC 348 CPSC 2010 348 CPSC.gov Questionnaire 8-24-2010.xlsx	Form and Instruction
347 DOT Intranet 347 DOT Intranet 2010 347 DOT Intranet 7-15-2010.xls	Form and Instruction
346 DoD Navy 346 DoD Navy 2010 346 Proposed Questionnaire Template DOD Navy 7-22-10.xls	Form and Instruction
345 NIH NIGMS 345 NIH NIGMS 2010 345 NIH NIGMS Questionnaire Template FINAL.xls	Form and Instruction
344 CQs 344 CQs 7-19-10 2010 344 CQs for OMB 7-19-2010 to 8-8-2010.xlsx	Form and Instruction
343 Census 343 Census 2010 343 Census Questionnaire _Template 7-16-10proposed.xls	Form and Instruction
339 CQs 339 CQs 7-6-10 2010 339 CQs for OMB 7-6-2010 to 7-18-2010.xlsx	Form and Instruction
340 DOT 340 DOT 2010 340 DOT VERSION_VHA_Medical_Centers_Questionnaire_Template.xls	Form and Instruction
334 NRC 334 NRC 2010 334 NRC Questionnaire with Transparency 6.8.10.xlsx	Form and Instruction
333 CQs 333 CQs 6-8-10 2010 333 CQs for OMB 6-8-2010 to 7-6-2010.xlsx	Form and Instruction
324 VBA 324 VBA 324 VBA_Survey FINAL_5-17-10_FSR.xls	Form and Instruction
323 SSA 323 SSA Policy Pages 323 SSA Policy Pages Final 5-19-10.xls	Form and Instruction
322 CQs 322 CQs 5-19-10 322 CQs for OMB 5-19-2010 to 6-7-2010.xlsx	Form and Instruction
316 FDIC 316 FDIC CQs 316 FDIC Custom Questions.xls	Form and Instruction
315 DHS CBP 315 DHS CBP 315 DHS CBP.xls	Form and Instruction
314 CQs 314 CQs 5-3-10 314 C ustom Qestions 5-3 to 5-19-2010.xls	Form and Instruction
313 CDC Mobile 313 CDC Mobile 313 CDC Mobile Survey Final 3.5.10.xls	Form and Instruction
312 CQs 312 CQs 4-14-10 312 CQs for OMB 4-14-2010 to 5-2-2010.xls	Form and Instruction
310 RRB 310 RRB 310 RRB Final 4-13-10.xls	Form and Instruction
311 CQs 311 CQs 3-29-10 311 Custom Qs 3-29-2010 to 4-13-2010.xls	Form and Instruction
306 CQs 306 CQs 3-2-10 306 Cust Ques 3-2-2010 to 3-28-2010.xls	Form and Instruction
305 State Careers 305 State Careers v2 305 State Careers v2 Questionnaire Master.xls	Form and Instruction
304 DOT NHTSA 304 DOT NHTSA 304 DOT NHTSA 031910.xls	Form and Instruction
302 CQs 302 CQs 2-5-10 302 Custom Questions 2-5-2010 to 3-1-2010.xls	Form and Instruction
301 DoD AF 301 DoD AF v2 301 DOD Air Force v2 Questionnaire Template 1-28-10.xls	Form and Instruction
300 CQs 300 CQs 1-16-10 300 Multiple Custom Questions for OMB 1-16-2010 to 2-5-2010.xls	Form and Instruction
299 State IIP 299 State IIP Embassy 299 State - IIP - Embassy Questionnaire.xls	Form and Instruction
292 DHS CIS Spanis 292 DHS CIS Spanish 292 DHS CIS Spanish FINAL 11-30-09.xls	Form and Instruction
293 DHS CIS Welcom 293 DHS CIS Welcome 293 DHS CIS Welcome Questionnaire Custom Questions FINAL.xls	Form and Instruction
291 DHS CIS 291 DHS CIS 291 DHS CIS Questionnaire FINAL 11-30-09.xls	Form and Instruction
290 CQs 290 CQs 12-4-09 290 Custom Questions for OMB clearance 12-4-09.xls	Form and Instruction
289 NIH Genome 289 NIH Genome 289 NIH Genome 1-6-2010.xls	Form and Instruction
287 CQs 286 CQs 11-16-09 287 Custom Questions for OMB 11-16-09 to 12-4-09.xls	Form and Instruction
286 HHS ONC 286 HHS ONC 286 HHS ONC_Questions_FINAL 12-4-09.xls	Form and Instruction
285 DHS CIS E Vfy 285 DHS CIS E Vfy 285 DHS CIS eVerify Questionnaire FINAL 12-4-09.xls	Form and Instruction
283 Master Questio 283 Master Questions List as of 11-17-09 283 Master Questions List as of 11-17-09.xls	Form and Instruction
281 State Mobile 281 State Mobile 281 Mobile Template Dept of State 11-6-09.xls	Form and Instruction
282 DHS New Model 282 DHS New Model 11-6-09 282 DHS Questionnaire Finalized New Model 11-6-09.xls	Form and Instruction
280 CMS FCSO CQs 280 CMS FCSO CQs 280 CMS FCSO Custom Questions for OMB 10-26-09.xls	Form and Instruction
277 FEMA Main 277 FEMA Main v2 277 FEMA Main V2 10-6-09.xls	Form and Instruction
276 EPA New Model 276 EPA New Model 276 EPA New Model 9.30.09 received 10-6-09.xls	Form and Instruction
275 CQs NCI 275 CQs NCI 275 Custom Qs NCI 10-6-09.xls	Form and Instruction
274 CQs CMS 274 CQs CMS 274 Custom Qs CMS 10-6-09.xls	Form and Instruction
309 ResearchGov 309 ResearchGov 3-09_Client Approved DRAFT Research gov Suggested Questions_FINAL.xls	Form and Instruction
AHRQ CAHPS AHRQ CAHPS AHRQ CAHPS Questionnaire_Template FINAL.xls	Form and Instruction
CFTC v2 CFTC v2 CFTC V2 questionnaire FINAL.xls	Form and Instruction
CitizenFeedback CitizenFeedback CitizenFeedback Questionaire NEW 6.xls	Form and Instruction
DHS CIS DHS CIS Welcome DHS CIS Welcome Questionnaire_Template FINAL.xls	Form and Instruction
FEMA Dis Asst FEMA Disaster Assistance FEMA - DisasterAssistance Questionnaire for OMB Approval.xls	Form and Instruction
247 DoD AF 247 DoD Air Force FSR 247 DOD Air Force.xls	Form and Instruction
260 Obama Directiv 260 Obama Directive FSR_260_Obama_Directive(1).xls	Form and Instruction
265 FTC Comp Asst 265 FTC Complaint Assistant FTC ComplaintAssistant questionnaire FINAL.xls	Form and Instruction
271 Treas IRS 271 Treas IRS IRS Questionnaire 8-5-09.xls	Form and Instruction
267 HHS NIDCR 267 HHS NIDCR Spanish CQs NIDCR Spanish custom questions for OMB.xls	Form and Instruction
NLM OSA 4-1-09 NLM OSA 4-1-09 NLM OSA Questionnaire FINAL 040109.xls	Form and Instruction
273 OnGuardOnLine 273 FTC OnGuardOnLine OnGuardOnline final survey 081309.xls	Form and Instruction
Redesign CQs Redesign CQs Redesign CQ's for OMB Approval.xls	Form and Instruction
263 Social Media Q 263 Social Media Questions Social Media Q variations.doc	Form and Instruction
State Travel State Travel Travel.State Questionnaire Template FINAL.xls	Form and Instruction
VA e-Benefits VA e-Benefits VA-eBenefits_Questionnaire FINAL.xls	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Previously Cleared ICs from prior Generic ICR

Agency IC Tracking Number:

FSR 1-1-09 thru 10-17-11

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA e-Benefits	VA e-Benefits	VA-eBenefits_Questionnaire FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CFTC v2	CFTC v2	CFTC V2 questionnaire FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	350 FDA	350 FDA 8-11-10	2010 350 FDA Email Model - 8.11.10 FINAL.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	349 CQs	349 CQs 8-9-10	2010 349 CQs for OMB 8-9-2010 to 8-25-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	348 CPSC	348 CPSC	2010 348 CPSC.gov Questionnaire 8-24-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	347 DOT Intranet	347 DOT Intranet	2010 347 DOT Intranet 7-15-2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	346 DoD Navy	346 DoD Navy	2010 346 Proposed Questionnaire Template DOD Navy 7-22-10.xls	Yes	Yes	Fillable Fileable
Form and Instruction	345 NIH NIGMS	345 NIH NIGMS	2010 345 NIH NIGMS Questionnaire Template FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	344 CQs	344 CQs 7-19-10	2010 344 CQs for OMB 7-19-2010 to 8-8-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	343 Census	343 Census	2010 343 Census Questionnaire _Template 7-16-10proposed.xls	Yes	Yes	Fillable Fileable
Form and Instruction	339 CQs	339 CQs 7-6-10	2010 339 CQs for OMB 7-6-2010 to 7-18-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	340 DOT	340 DOT	2010 340 DOT VERSION_VHA_Medical_Centers_Questionnaire_Template.xls	Yes	Yes	Fillable Fileable
Form and Instruction	334 NRC	334 NRC	2010 334 NRC Questionnaire with Transparency 6.8.10.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	333 CQs	333 CQs 6-8-10	2010 333 CQs for OMB 6-8-2010 to 7-6-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	324 VBA	324 VBA	324 VBA_Survey FINAL_5-17-10_FSR.xls	Yes	Yes	Fillable Fileable
Form and Instruction	323 SSA	323 SSA Policy Pages	323 SSA Policy Pages Final 5-19-10.xls	Yes	Yes	Fillable Fileable
Form and Instruction	322 CQs	322 CQs 5-19-10	322 CQs for OMB 5-19-2010 to 6-7-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	316 FDIC	316 FDIC CQs	316 FDIC Custom Questions.xls	Yes	Yes	Fillable Fileable
Form and Instruction	315 DHS CBP	315 DHS CBP	315 DHS CBP.xls	Yes	Yes	Fillable Fileable
Form and Instruction	314 CQs	314 CQs 5-3-10	314 C ustom Qestions 5-3 to 5-19-2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	313 CDC Mobile	313 CDC Mobile	313 CDC Mobile Survey Final 3.5.10.xls	Yes	Yes	Fillable Fileable
Form and Instruction	290 CQs	290 CQs 12-4-09	290 Custom Questions for OMB clearance 12-4-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	312 CQs	312 CQs 4-14-10	312 CQs for OMB 4-14-2010 to 5-2-2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	310 RRB	310 RRB	310 RRB Final 4-13-10.xls	Yes	Yes	Fillable Fileable
Form and Instruction	311 CQs	311 CQs 3-29-10	311 Custom Qs 3-29-2010 to 4-13-2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	306 CQs	306 CQs 3-2-10	306 Cust Ques 3-2-2010 to 3-28-2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	305 State Careers	305 State Careers v2	305 State Careers v2 Questionnaire Master.xls	Yes	Yes	Fillable Fileable
Form and Instruction	304 DOT NHTSA	304 DOT NHTSA	304 DOT NHTSA 031910.xls	Yes	Yes	Fillable Fileable
Form and Instruction	302 CQs	302 CQs 2-5-10	302 Custom Questions 2-5-2010 to 3-1-2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	301 DoD AF	301 DoD AF v2	301 DOD Air Force v2 Questionnaire Template 1-28-10.xls	Yes	Yes	Fillable Fileable
Form and Instruction	300 CQs	300 CQs 1-16-10	300 Multiple Custom Questions for OMB 1-16-2010 to 2-5-2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	299 State IIP	299 State IIP Embassy	299 State - IIP - Embassy Questionnaire.xls	Yes	Yes	Fillable Fileable
Form and Instruction	292 DHS CIS Spanish	292 DHS CIS Spanish	292 DHS CIS Spanish FINAL 11-30-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	293 DHS CIS Welcome	293 DHS CIS Welcome	293 DHS CIS Welcome Questionnaire Custom Questions FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	291 DHS CIS	291 DHS CIS	291 DHS CIS Questionnaire FINAL 11-30-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	289 NIH Genome	289 NIH Genome	289 NIH Genome 1-6-2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	287 CQs	286 CQs 11-16-09	287 Custom Questions for OMB 11-16-09 to 12-4-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	286 HHS ONC	286 HHS ONC	286 HHS ONC_Questions_FINAL 12-4-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	285 DHS CIS E Vfy	285 DHS CIS E Vfy	285 DHS CIS eVerify Questionnaire FINAL 12-4-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	283 Master Questions List	283 Master Questions List as of 11-17-09	283 Master Questions List as of 11-17-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	281 State Mobile	281 State Mobile	281 Mobile Template Dept of State 11-6-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	282 DHS New Model	282 DHS New Model 11-6-09	282 DHS Questionnaire Finalized New Model 11-6-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	280 CMS FCSO CQs	280 CMS FCSO CQs	280 CMS FCSO Custom Questions for OMB 10-26-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	277 FEMA Main	277 FEMA Main v2	277 FEMA Main V2 10-6-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	276 EPA New Model	276 EPA New Model	276 EPA New Model 9.30.09 received 10-6-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	275 CQs NCI	275 CQs NCI	275 Custom Qs NCI 10-6-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	274 CQs CMS	274 CQs CMS	274 Custom Qs CMS 10-6-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	309 ResearchGov	309 ResearchGov	3-09_Client Approved DRAFT Research gov Suggested Questions_FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	AHRQ CAHPS	AHRQ CAHPS	AHRQ CAHPS Questionnaire_Template FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	398 CQs	398 CQs	2011 398 CQs for OMB 12-14-2010 to 1-11-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	399 NIDCR	399 NIDCR English 2011	2011 399 NIDCR English 2011 Questionnaire.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	400 NGS NOAA	400 NGS NOAA	2011 400 Questionnaire_NGSNOAA_12-16-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	401 CDC	401 CDC	2011 401 CDC_New_Questionnaire_12_27_2010_FINAL3.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	404 VOA	404 VOA	2011 404 VOA English V2 Questionnaire _Template.xls	Yes	Yes	Fillable Fileable
Form and Instruction	405 CQs 1-11-11	405 CQs 1-11-11	2011 405 CQs for OMB 1-11-2011 to xxxx.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	406 GSA	406 GSA Auctions	2011 406 GSA Auctions FINAL 1-12-11.xls	Yes	Yes	Fillable Fileable
Form and Instruction	407 GSA	407 GSA Xcess	2011 407 GSA Xcess FINAL 1-7-11.xls	Yes	Yes	Fillable Fileable
Form and Instruction	408 RegInfo	408 RegInfo	2011 408 Questionnaire RegInfo v2.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	414 ePSS	414 ePSS Wave 1	2011 414 ePSS Questionnaire Wave 1 Revised.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	415 FCIC	415 FCIC Cons Action CQs	2011 415 FCIC Consumer Action CQ revisions_11Feb2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	416 FCIC	416 FCIC Pueblo	2011 416 FCIC Pueblo Survey revisions_11Feb2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	417 HowTo	417 HowTo	2011 417 Howto.gov Survey 3.7.2011 - current.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	418 NLM	418 NLM Clinical Trials	2011 418 NLM Clinical Trials Questionnaire _2-14-11.xls	Yes	Yes	Fillable Fileable
Form and Instruction	419 CMS	419 CMS Palmetto GBA J11 MAC	2011 419 CMS Palmetto GBA J11 MAC Questionnaire 3-10-11.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	420 CQs	420 CQs 2-4-11	2011 420 CQs for OMB 2-4-2011 to 3-25-11.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	421 DHHS PSC	421 DHHS PSC Offline	2011 421 DHHS-PSC Offline Services Questionnaire 02-25-11.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	422 DOT	422 DOT FHWA	2011 422 DOT FHWA Questionnaire 02-17-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	423 DOJ	423 DOJ COPS Pub Mo	2011 423 DOJ COPS Publication MonthlySurvey FY2011 UPDATED 3_18.docx	Yes	Yes	Fillable Fileable
Form and Instruction	424 AHRQ	424 AHRQ Eff Health Care	2011 424 AHRQ Effective Health Care.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	425 FEMA	425 FEMA Mobile	2011 425 FEMA Mobile Survey Final 2.28.11.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	426 NIST	426 NIST Sat v 3-28-11	2011 426 NIST Sat Survey v2 03-28-11.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	427 CQs	427 CQs 3-25-11	2011 427 CQs for OMB 3-25-2011 to 4-8-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	431 CQs	431 CQs 4-8-11	2011 431 CQs for OMB 4-8-2011 to 4-28-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	432 FEMA	432 FEMA ReadyGov	2011 432 FEMA Readygov_Template_4.13.11.xls	Yes	Yes	Fillable Fileable
Form and Instruction	433 BenefitsGov	433 BenefitsGov	2011 433 Benefits.gov.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	439 FMCSA	439 FMCSA Passenger Carrier	2011 439 FMCSA Passenger Carrier Satisfaction Survey.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	440 FMCSA	440 FMCSA Protect Your Move	2011 440 FMCSA Protect Your Move Satisfaction Survey V2.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	441 FMCSA	441 FMCSA v2	2011 441 FMCSA Satisfaction Survey v2.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	443 CQs	443 CQs 4-28-11	2011 443 CQs for OMB started 4-28-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	457 CQs	457 CQs 5-17-11	2011 457 CQs for OMB started 5-17-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	458 NICHD	458 NICHD	2011 458 NICHD Survey.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	459 US Courts	459 US Courts	2011 459 US Courts Survey.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	460 US Embassies	460 US Embassies Enterprise	2011 460 US Embassies Enterprise Survey.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	461 CMS	461 CMS Medicare Plan Finder	2011 461 CMS Medicare Plan Finder.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	462 CQs	462 CQs 6-14-11	2011 462 CQs for OMB started 6-14-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	463 DoD	463 Dod Enterprise	2011 463 DoD Enterprise Measure Questionnaire.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	471 Health IT	471 Health IT	2011 471 Copy of HealthIT+qnaire+for+dataload+final.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	472 CQs	472 CQs 7-8-11	2011 472 CQs for OMB started 7-8-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	473 SSA	473 SSA iClaim v2	2011 473 SSA iClaim v2.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	478 FSIS	478 FSIS Intranet	2011 478 FSIS Intranet Questionnaire_8-9-11.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CitizenFeedback	CitizenFeedback	CitizenFeedback Questionaire NEW 6.xls	Yes	Yes	Fillable Fileable
Form and Instruction	DHS CIS	DHS CIS Welcome	DHS CIS Welcome Questionnaire_Template FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	FEMA Dis Asst	FEMA Disaster Assistance	FEMA - DisasterAssistance Questionnaire for OMB Approval.xls	Yes	Yes	Fillable Fileable
Form and Instruction	247 DoD AF	247 DoD Air Force	FSR 247 DOD Air Force.xls	Yes	Yes	Fillable Fileable
Form and Instruction	260 Obama Directive	260 Obama Directive	FSR_260_Obama_Directive(1).xls	Yes	Yes	Fillable Fileable
Form and Instruction	265 FTC Comp Asst	265 FTC Complaint Assistant	FTC ComplaintAssistant questionnaire FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	271 Treas IRS	271 Treas IRS	IRS Questionnaire 8-5-09.xls	Yes	Yes	Fillable Fileable
Form and Instruction	267 HHS NIDCR	267 HHS NIDCR Spanish CQs	NIDCR Spanish custom questions for OMB.xls	Yes	Yes	Fillable Fileable
Form and Instruction	NLM OSA 4-1-09	NLM OSA 4-1-09	NLM OSA Questionnaire FINAL 040109.xls	Yes	Yes	Fillable Fileable
Form and Instruction	479 CQs	479 CQs 7-26-11	2011 479 CQs for OMB started 7-26-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	481 FBI	481 FBI v3	2011 481 FBI V3 Questionnaire.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	483 CQs	483 CQs 9-15-11	2011 483 CQs for OMB started 9-15-2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	484 Healthfinder	484 Healthfinder v2	2011 484 Healthfinder -V2 - October 2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	485 NIAID	485 NIAID	2011 485 NIAID October 2011.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	362 Medicare	362 Medicare	2010 362 Final Questionnaire_Medicare.gov_09.07.2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	486 PBGC	486 PBGC v3	2011 486 PBGC.gov V3.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	487 SSA	487 SSA Extra Help v2 Eng Equiv	2011 487 SSA Extra Help V2 (English Eqiv).xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	394 DHS CIS	394 DHS CIS Citizenship Resource Center	2010 394 DHS CIS Citizenship Resource Center 11-18-10FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	393 CQs	393 CQs 11-29-10	2010 393 CQs for OMB 11-29-2010 to 12-14-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	392 USTTB CQs	392 USTTB CQs	2010 392 USTTB Custom Questions 11.29.10 v2.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	387 CQs	387 CQs 11-3-10	2010 387 CQs for OMB 11-3-2010 to 11-29-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	386 DOJ	386 DOJ BJS	2010 386 DOJ - BJS Questionnaire.xls	Yes	Yes	Fillable Fileable
Form and Instruction	385 CVC	385 CVC	2010 385 Capitol Visitor CenterQuestionnaire.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	384 PSC	384 DHHS PSC	2010 384 PSC Questionnaire Draft customer approved.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	383 FedsHireVets	383 OPM FedsHireVets	2010 383 FedsHireVets FINAL Questionnaire 110810.xls	Yes	Yes	Fillable Fileable
Form and Instruction	382 FCA	382 FCA	2010 382 FCA Draft Questionnaire.xls	Yes	Yes	Fillable Fileable
Form and Instruction	378 CQs	378 CQs 10-17-10	2010 378 CQs for OMB 10-17-2010 to 11-3-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	377 USPTO	377 USPTO Revised	2010 377 Qnaire_USPTO_October_CB_Revised.xls	Yes	Yes	Fillable Fileable
Form and Instruction	373 CQs	373 CQs 9-21-10	2010 373 CQs for OMB 9-21-2010 to 10-17-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	372 PBGC	372 PBGC My PAA v3	2010 372 PBGC My PAA v3 Questionnaire 10-4-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	371 NLM	371 NLM Exhibition	2010 371 NLM Exhibition Survey Template_9_10.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	370 MyMoney	370 MyMoney	2010 370 MyMoney gov Questionnaire Template 9-17-10FINAL.xls	Yes	Yes	Fillable Fileable
Form and Instruction	369 GobiernoUSA	369 GobiernoUSA	2010 369 GobiernoUSA Questionnaire 9 28 10.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	366 CQs	366 CQs 8-25-10	2010 366 CQs for OMB 8-25-2010 to 9-21-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	365 CPSC	365 CPSC	2010 365 CPSC.gov Questionnaire 8-24-2010.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	364 RE and S-RE	364 RE and S-RE	2010 364 Survey Final - RE and S-RE, August 2010.xls	Yes	Yes	Fillable Fileable
Form and Instruction	363 NIH	363 NIH NIDCD	2010 363 NIH NIDCD.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	273 OnGuardOnLine	273 FTC OnGuardOnLine	OnGuardOnline final survey 081309.xls	Yes	Yes	Fillable Fileable
Form and Instruction	Redesign CQs	Redesign CQs	Redesign CQ's for OMB Approval.xls	Yes	Yes	Fillable Fileable
Form and Instruction	263 Social Media Quest	263 Social Media Questions	Social Media Q variations.doc	Yes	Yes	Fillable Fileable
Form and Instruction	State Travel	State Travel	Travel.State Questionnaire Template FINAL.xls	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 660,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	660,000	660,000
Annual IC Time Burden (Hours)	27,500	27,500
Annual IC Cost Burden (Dollars)	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.