2014 EIS Conference Customer Feedback Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 0920-0919 can be found here:

Documents and Forms

Document Name Document Type
2014 EIS Conference Customer Feedback Survey Form
Survey Screenshots Att 1a_EIS Conference Survey Screenshots 04012014.docx Form
GenIC Clearance Submission EIS 04012014.docx Request for Clearance IC Document
Att 1_EIS Conf Eval Questions 04012014.docx Survey Word Version IC Document

Information Collection (IC) Details

IC Title:	2014 EIS Conference Customer Feedback Survey	Agency IC Tracking Number:	14SS

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
Form	none	Survey Screenshots	Att 1a_EIS Conference Survey Screenshots 04012014.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Clearance	GenIC Clearance Submission EIS 04012014.docx	04/03/2014
Survey Word Version	Att 1_EIS Conf Eval Questions 04012014.docx	04/03/2014

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