Information Collection

2014 EIS Conference Customer Feedback Survey

IC 211095 under ICR 201112-0920-014 · OMB 0920-0919.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0919 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.