Information Collection Request

Understanding the Value of Service Survey

ICR 201205-3045-002 · OMB 3045-0147 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 2 Member Experience Survey Form and Instruction New Available
Form 1 Member Experience Pre-screening questions Form and Instruction New Available
Part B.docx Supporting Statement B Uploaded 2012-05-30 Available
Justification_v5_11-13-12.docx Supporting Statement A Uploaded 2012-11-15 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
202505 Member Experience Web Survey Form and Instruction NewMember Experience Survey
202505 Member Experience Web Survey Form and Instruction NewMember Experience Pre-screening questions

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2015 36 Months From Approved
4,000 0 0
1,333 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Member Experience Web Survey 1, 2 ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,000 0 0 4,000 0 0
Annual Time Burden (Hours) 1,333 0 0 1,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No