Member Experience Web Survey

Understanding the Value of Service Survey

Documents and Forms

Document Name Document Type
Form 1 Member Experience Web Survey Form and Instruction
1 Member Experience Pre-screening questions FINAL UPE Pre-Screen.docx www.nationalservice.gov Form and Instruction
2 Member Experience Survey CNCS_FINAL WITH Disab UPE Survey_11-13-12.docx www.nationalservice.gov Form and Instruction

Information Collection (IC) Details

IC Title:	Member Experience Web Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	Member Experience Pre-screening questions	FINAL UPE Pre-Screen.docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable
Form and Instruction	2	Member Experience Survey	CNCS_FINAL WITH Disab UPE Survey_11-13-12.docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	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	4,000	4,000
Annual IC Time Burden (Hours)	1,333	1,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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