Information Collection

OIT Customer Satisfaction Survey - Service Ticket

IC 204735 under ICR 201205-0917-002 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Document Name Document Type
Form 0917-0036-13 OIT Customer Satisfaction Survey - Service Ticket Form and Instruction
0917-0036-13 OIT Customer Satisfaction Survey-Service Ticket, OMB For OMB Form No 0917-0036-13 10_25_12.docx www.surveymonkey.com/s/P8VRKFQ Form and Instruction
OMB No 0917-0036-13 OIT Customer Satisfaction Survey- Service Ticket.doc OMB No. 0917-0036-13 Mini-Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OIT Customer Satisfaction Survey - Service Ticket	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	0917-0036-13	OIT Customer Satisfaction Survey-Service Ticket, OMB Form No. 0917-0036-13	OMB Form No 0917-0036-13 10_25_12.docx	https://www.surveymonkey.com/s/P8VRKFQ	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No. 0917-0036-13 Mini-Supporting Statement	OMB No 0917-0036-13 OIT Customer Satisfaction Survey- Service Ticket.doc	10/25/2012

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