Office of Equity, Diversity, and Inclusion (EDI) Customer Service Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (OD/OER)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Office of Equity, Diversity, and Inclusion (EDI) Customer Service Survey Form and Instruction
1 EDI Customer Service Survey EDI Customer Service Survey1.docx Form and Instruction
Fast-Track template_EDI.doc Fast-Track Template - EDI IC Document

Information Collection (IC) Details

IC Title:	Office of Equity, Diversity, and Inclusion (EDI) Customer Service 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
Form and Instruction	1	EDI Customer Service Survey	EDI Customer Service Survey1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast-Track Template - EDI	Fast-Track template_EDI.doc	05/22/2014

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