Information Collection

Member Experience Web Survey

IC 202505 under ICR 201205-3045-002 · OMB 3045-0147.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Member Experience Pre-screening questions Member Experience Web Survey	Form and Instruction
Form 2 Member Experience Survey Member Experience Web Survey	Form and Instruction
1 Member Experience Pre-screening questions FINAL UPE Pre-Screen.docx	Form and Instruction
2 Member Experience Survey CNCS_FINAL WITH Disab UPE Survey_11-13-12.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	1			www.nationalservice.gov	Yes	Yes	Fillable Fileable
Form and Instruction	2			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 %

table that charts list of burden
	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

table that charts IC Documents
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].