American Customer Satisfaction Index "Customer Satisfaction Surveys"

Forms and Documents

Document Name	Status
Form 688 2015 687 FinCEN Portal_Query - 2015 692 NWS Quarterly Survey Form and Instruction	New
Form 684 2015 684 FinCENC BSA E-Filing Customer Survey - 2015 686 Domestic Analytic Products Survey Form and Instruction	New
Form 683 2015 683 RRB Rail Employers Survey Form and Instruction	New
Form 682 2015 682 NASS Customer Satisfaction Survey Final Form and Instruction	New
Form 681 2014 680 VHAOutpatient Survey = 2014 681 VHA Inpatient Survey Form and Instruction	New
Form 679 2014 679 NASA LANCE Questionnaire Form and Instruction	New
Form 678 2014 678 E-Verification Customer Satisfaction Survey Form and Instruction	New
Form 677 2014 677 USDA Forest Service RD Customer Satisfaction Questionnaire Form and Instruction	New
Form 676 2014 676 State Passport Services Survey Form and Instruction	New
Form 675 2014 675 NWS_General Form and Instruction	New
Form 673 2014 673 HRSA BPHC Health Care Program Survey - 2014 674 EOSDIS Questionnaire Form and Instruction	New
Form 664 664 NWS_Internet_Panel - 672 USDA FSIS Call Center Form and Instruction	New
Form 663 663 2014 Local Officials Survey Form and Instruction	New
Form 662 2014 662 FinCEN Resource Center Customer Survey Form and Instruction	New
Form 660 2014 660 SBA ODA Customer Satisfaction Survey - 2014 661 Department of Ed CFO Grantee Satisfaction Survey Form and Instruction	New
Form 559 2014 556 PBGC Premium Filer Questionnaire - 2014 559 LBI ACSI Questionnaire Form and Instruction	New
Form 551 551 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2014 555 FAA Air Traffic Control Organization Quarterly FSS Survey Form and Instruction	New
Form 550 2014 549 NHSC Participant Questionnaire - 2014 550 Nurse Corps Participant Questionnaire Form and Instruction	New
Form 545 2014 545 VA OI&TContinuous Survey (Large) - 2014 547 VA OI&T Continuous Survey (Small) Form and Instruction	New
Form 544 2014 544 HRSA HAB Grantee Questionnaire Form and Instruction	New
Form 542 2014 542 PBGC Retiree Instrument - 2014 543 PBGC Participant Caller Instrument Form and Instruction	New
Form 541 2014 541 FEMA BSB Printed Pubs Sat Survey Form and Instruction	New
Form 539 2014 539 FinCEN BSA E-Filing Customer Survey - 2014 540 FinCEN Compliance MOU Customer Survey Form and Instruction	New
Form 538 2013 538 Final NCES Questionniare Form and Instruction	New
Form 535 2013 535 ACSI CHAMPVA Questions - 2013 537 ACSI SB Questions Form and Instruction	New
Form 534 2013 531 HRSA Nurse Corp LRP and SP Critical Shortage Facilities - 2013 534 E-Verification Customer Satisfaction Survey Form and Instruction	New
Form 529 2013 529 FinCEN Domestic Analytic Products Survey - 2013 530 NASA EOSDIS Questionnaire Form and Instruction	New
Form 527 2013 527 CMS MAC Questionniare - 2013 528 HRSA MCHB - MIECHV Questionnaire Form and Instruction	New
Form 526 2013 526 NHSC Participant Questionnaire Form and Instruction	New
Form 525 2013 525 HRSA Nurse Corp LRP and SP Form and Instruction	New
Form 523 2013 523 HRSA HAB Grantee - 2013 524 FINCEN Portal_Query Form and Instruction	New
Form 522 522 PBGC Participant Caller Form and Instruction	New
Form 298 298 HRSA MCHB Resource Center Satisfaction Survey Form and Instruction	New
Form 329 329 FAA ATO Satisfaction Survey Form and Instruction	New
Form 335 335 GSA State and Local Programs Survey Form and Instruction	New
Form 342 342 SEC OIEA Jul 2010 Questionnaire Call Cente Form and Instruction	New
Form 351 351 ED NCES Satisfaction Survey Form and Instruction	New
Form 353 353 EEOC Contact Center Customer Satisfaction Survey Form and Instruction	New
Form 356 356 CNCS Learn and Serve America Grantees Form and Instruction	New
Form 357 357 CNCS Senior Corps Grantee Satisfaction Survey Form and Instruction	New
Form 358 358 AmeriCorps State and National Grantees Form and Instruction	New
Form 359 359 CNCS Vista Program Survey Form and Instruction	New
Form 360 360 AmeriCorps NCCC Survey Form and Instruction	New
Form 367 367 NCA Customer Satisfaction Survey Form and Instruction	New
Form 368 368 GSA FCIC Customer Satisfaction Survey Form and Instruction	New
Form 375 375 DTIC Customer Satisfaction Survey Form and Instruction	New
Form 376 376 AFI Grantee Satisfaction Survey Form and Instruction	New
Form 380 380 VA VHA Inpatient Survey Form and Instruction	New
Form 381 381 VA VHA Outpatient Survey Form and Instruction	New
Form 389 389 Tricare Outpatient Survey Form and Instruction	New
Form 390 390 Tricare Inpatient Survey Form and Instruction	New
Form 391 391 UDSA Rural Development Survey Water-B&I-Multifamily Form and Instruction	New
Form 402 402 U.S. Mint Numismatic/Commemorative Coins Survey Form and Instruction	New
Form 403 403 USDA FAS Survey Form and Instruction	New
Form 409 409 VHA Champ VA Questionnaire Form and Instruction	New
Form 410 410 DOJ COPS TTA Recipients Quarterly Form and Instruction	New
Form 413 413 U.S. Mint Collectible Coins Survey Form and Instruction	New
Form 423 423 DOJ COPS Monthly Publication Survey Form and Instruction	New
Form 429 429 VBA Insurance Claims Questionnaire Form and Instruction	New
Form 430 430 VBA 2011 Call Center Questionnaire Form and Instruction	New
Form 438 438 HRSA BCRS NHSC 2011 Partner Questionnaire Form and Instruction	New
Form 444 444 Social Security Administration Call Center Questionnaire Form and Instruction	New
Form 449 449 USDA NRCS Nutrient Management Program Survey Form and Instruction	New
Form 450 450 FAA Carriers Ops Mgt Questionnaire Form and Instruction	New
Form 451 451 FAA Manufacturers Questionnaire Form and Instruction	New
Form 452 452 FAA Repair Station Questionnaire Form and Instruction	New
Form 454 454 USDA RD FINAL Questionnaire RCD Grant RBS Form and Instruction	New
Form 455 455 E-Verify Enrollment Customer Satisfaction Survey Form and Instruction	New
Form 456 456 USDA Rural Development Questionnaire Rural Electrification Program Form and Instruction	New
Form 470 470 USDA Rural Development Questionnaire Rural Housing and Community Facilities Loans Form and Instruction	New
Form 475 475 USCIS Asylum Customer Satisfaction Survey Form and Instruction	New
Form 477 477 NIST Ambulance Design Form and Instruction	New
Form 480 480 US Mint Call Center Questionnaire Form and Instruction	New
Form 481 481 RRB Unemployment and Sickness Benefits Questionnaire Form and Instruction	New
Form 483 483 AMS MN Customer Satisfaction Survey Form and Instruction	New
Form 484 484 GSA Federal Supplier Greenhouse Gas Emissions Inventory Pilot Questionnaire Form and Instruction	New
Form 485 485 HRSA HAB Grantee Questionnaire Form and Instruction	New
Form 496 486 FEMA - BSB Printed Pubs Sat_Survey Form and Instruction	New
Form 487 487 FinCEN Compliance MOU Customer Survey Form and Instruction	New
Form 488 488 FinCEN Regulatory Resource Center Customer Survey Form and Instruction	New
Form 489 489 FinCEN Secure Outreach_WebCBRS Survey Form and Instruction	New
Form 490 490 Recreation Customer Service Survey Form and Instruction	New
Form 491 491 CMS Contractor Satisfaction Survey Form and Instruction	New
Form 492 492 PBGC Retiree Instrument Form and Instruction	New
Form 493 493 PBGC Participant Caller Instrument Form and Instruction	New
Form 494 494 HRSA NELRP and NSP 2012 Participant Questionnaire Form and Instruction	New
Form 495 495 DOJ JAG Questionnaire Form and Instruction	New
Form 496 496 PBGC Premium Filer Questionnaire Form and Instruction	New
Form 497 497 USCIS IO Questionnaire Form and Instruction	New
Form 498 498 FinCEN BSA E-Filing Survey Form and Instruction	New
Form 499 499 FINCEN Domestic Analytic Products Form and Instruction	New
Form 500 500 FINCEN Foreign Analytical Case Reports Form and Instruction	New
Form 501 501 FINCEN SAR Activity Review Form and Instruction	New
Form 502 502 HRSA BCRS NHSC Participant Survey Form and Instruction	New
Form 503 503 ED CFO Grantee Survey Form and Instruction	New
Form 504 504 FEMA Local Officials Questionnaire Form and Instruction	New
Form 505 505 FEMA General Public Survey Form and Instruction	New
Form 506 506 OCS Grantee Satisfaction Survey Form and Instruction	New
Form 507 507 RRB Survivor Customer Satisfaction Survey Form and Instruction	New
Form 508 508 SBA ODA Customer Satisfaction Survey Form and Instruction	New
Form 509 509 FAA Mechanics Customer Satisfaction Survey Form and Instruction	New
Form 510 510 FAA Carries Ops & Carriers Pilots Form and Instruction	New
Form 511 511 IRS LB&I Survey Form and Instruction	New
Form 512 512 IRS SBSE Survey Form and Instruction	New
Form 513 513 IRS Individual Filers Survey Form and Instruction	New
Form 514 514 E-Verity Customer Contact Center Form and Instruction	New
Form 515 515 HRSA BPHC Grantee Survey Form and Instruction	New
Form 516 516 FAA General Aviation Survey Form and Instruction	New
Form 517 517 NASA EOSDIS Questionnaire Form and Instruction	New
Form 518 518 DOJ COPS Survey Form and Instruction	New
Form 519 519 National Weather Service Form and Instruction	New
Form 520 520 State BCS Survey Form and Instruction	New
Form 521 520 Forest Service R&D Program Questionnaire Form and Instruction	New
OVERVIEW OF THE ACSI BENCHMARK_3-5-13.doc Supplementary Document	2013-03-05
GUIDELINES PROVIDED TO AGENCIES.doc Supplementary Document	2013-02-20
1090-007 30 Day FR Notice.pdf Supplementary Document	2012-10-10
SS_for_1090-0007_Part_B_09282012.doc Supporting Statement B	2012-09-28
SS_for_1090-0007_Part_A_09262012.doc Supporting Statement A	2012-09-26
E._O._13571_Streamlining_Service_Delivery_and_Improving_Customer_Service[1].doc Supplementary Document	2012-09-14
1090-0007 60-Day Notice FSR.pdf Supplementary Document	2012-09-14
CFI_ACSI Methodology.pdf Supplementary Document	2009-08-14
ACSI Methodology Paper.pdf Supplementary Document	2009-08-13
CTA Comparison for OMB.pdf Supplementary Document	2009-08-10
E.O. 12,862.htm Supplementary Document	2009-08-05
E.O. 13,450.pdf Supplementary Document	2009-08-05
Government Performance Results Act of 1993.pdf Supplementary Document	2009-08-05

IC Document Collections

IC ID	Document Title	Status
215488	2015 687 FinCEN Portal_Query - 2015 692 NWS Quarterly Survey Form and Instruction	New
214742	2015 684 FinCENC BSA E-Filing Customer Survey - 2015 686 Domestic Analytic Products Survey Form and Instruction	New
214559	2015 683 RRB Rail Employers Survey Form and Instruction	New
214486	2015 682 NASS Customer Satisfaction Survey Final Form and Instruction	New
214084	2014 680 VHAOutpatient Survey = 2014 681 VHA Inpatient Survey Form and Instruction	New
213366	2014 679 NASA LANCE Questionnaire Form and Instruction	New
213329	2014 678 E-Verification Customer Satisfaction Survey Form and Instruction	New
213042	2014 677 USDA Forest Service RD Customer Satisfaction Questionnaire Form and Instruction	New
213001	2014 676 State Passport Services Survey Form and Instruction	New
212613	2014 675 NWS_General Form and Instruction	New
212539	2014 673 HRSA BPHC Health Care Program Survey - 2014 674 EOSDIS Questionnaire Form and Instruction	New
212354	664 NWS_Internet_Panel - 672 USDA FSIS Call Center Form and Instruction	New
212333	663 2014 Local Officials Survey Form and Instruction	New
212176	2014 662 FinCEN Resource Center Customer Survey Form and Instruction	New
212024	2014 660 SBA ODA Customer Satisfaction Survey - 2014 661 Department of Ed CFO Grantee Satisfaction Survey Form and Instruction	New
211780	2014 556 PBGC Premium Filer Questionnaire - 2014 559 LBI ACSI Questionnaire Form and Instruction	New
211764	551 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2014 555 FAA Air Traffic Control Organization Quarterly FSS Survey Form and Instruction	New
211619	2014 549 NHSC Participant Questionnaire - 2014 550 Nurse Corps Participant Questionnaire Form and Instruction	New
211450	2014 545 VA OI&TContinuous Survey (Large) - 2014 547 VA OI&T Continuous Survey (Small) Form and Instruction	New
211321	2014 544 HRSA HAB Grantee Questionnaire Form and Instruction	New
211035	2014 542 PBGC Retiree Instrument - 2014 543 PBGC Participant Caller Instrument Form and Instruction	New
210838	2014 541 FEMA BSB Printed Pubs Sat Survey Form and Instruction	New
210296	2014 539 FinCEN BSA E-Filing Customer Survey - 2014 540 FinCEN Compliance MOU Customer Survey Form and Instruction	New
209811	2013 538 Final NCES Questionniare Form and Instruction	New
208895	2013 535 ACSI CHAMPVA Questions - 2013 537 ACSI SB Questions Form and Instruction	New
207918	2013 531 HRSA Nurse Corp LRP and SP Critical Shortage Facilities - 2013 534 E-Verification Customer Satisfaction Survey Form and Instruction	New
207580	2013 529 FinCEN Domestic Analytic Products Survey - 2013 530 NASA EOSDIS Questionnaire Form and Instruction	New
207219	2013 527 CMS MAC Questionniare - 2013 528 HRSA MCHB - MIECHV Questionnaire Form and Instruction	New
206966	2013 526 NHSC Participant Questionnaire Form and Instruction	New
206658	2013 525 HRSA Nurse Corp LRP and SP Form and Instruction	New
206550	2013 523 HRSA HAB Grantee - 2013 524 FINCEN Portal_Query Form and Instruction	New
206035	522 PBGC Participant Caller Form and Instruction	New
204142	298 HRSA MCHB Resource Center Satisfaction Survey Form and Instruction	New
204140	329 FAA ATO Satisfaction Survey Form and Instruction	New
204139	335 GSA State and Local Programs Survey Form and Instruction	New
204138	342 SEC OIEA Jul 2010 Questionnaire Call Cente Form and Instruction	New
204137	351 ED NCES Satisfaction Survey Form and Instruction	New
204133	353 EEOC Contact Center Customer Satisfaction Survey Form and Instruction	New
204132	356 CNCS Learn and Serve America Grantees Form and Instruction	New
204131	357 CNCS Senior Corps Grantee Satisfaction Survey Form and Instruction	New
204130	358 AmeriCorps State and National Grantees Form and Instruction	New
204129	359 CNCS Vista Program Survey Form and Instruction	New
204128	360 AmeriCorps NCCC Survey Form and Instruction	New
204127	367 NCA Customer Satisfaction Survey Form and Instruction	New
204126	368 GSA FCIC Customer Satisfaction Survey Form and Instruction	New
204125	375 DTIC Customer Satisfaction Survey Form and Instruction	New
204123	376 AFI Grantee Satisfaction Survey Form and Instruction	New
204122	380 VA VHA Inpatient Survey Form and Instruction	New
204121	381 VA VHA Outpatient Survey Form and Instruction	New
204120	389 Tricare Outpatient Survey Form and Instruction	New
204119	390 Tricare Inpatient Survey Form and Instruction	New
204118	391 UDSA Rural Development Survey Water-B&I-Multifamily Form and Instruction	New
204117	402 U.S. Mint Numismatic/Commemorative Coins Survey Form and Instruction	New
204116	403 USDA FAS Survey Form and Instruction	New
204115	409 VHA Champ VA Questionnaire Form and Instruction	New
204113	410 DOJ COPS TTA Recipients Quarterly Form and Instruction	New
204112	413 U.S. Mint Collectible Coins Survey Form and Instruction	New
204111	423 DOJ COPS Monthly Publication Survey Form and Instruction	New
204110	429 VBA Insurance Claims Questionnaire Form and Instruction	New
204109	430 VBA 2011 Call Center Questionnaire Form and Instruction	New
204108	438 HRSA BCRS NHSC 2011 Partner Questionnaire Form and Instruction	New
204107	444 Social Security Administration Call Center Questionnaire Form and Instruction	New
204106	449 USDA NRCS Nutrient Management Program Survey Form and Instruction	New
204105	450 FAA Carriers Ops Mgt Questionnaire Form and Instruction	New
204104	451 FAA Manufacturers Questionnaire Form and Instruction	New
204103	452 FAA Repair Station Questionnaire Form and Instruction	New
204100	454 USDA RD FINAL Questionnaire RCD Grant RBS Form and Instruction	New
204099	455 E-Verify Enrollment Customer Satisfaction Survey Form and Instruction	New
204098	456 USDA Rural Development Questionnaire Rural Electrification Program Form and Instruction	New
204097	470 USDA Rural Development Questionnaire Rural Housing and Community Facilities Loans Form and Instruction	New
204096	475 USCIS Asylum Customer Satisfaction Survey Form and Instruction	New
204095	477 NIST Ambulance Design Form and Instruction	New
204094	480 US Mint Call Center Questionnaire Form and Instruction	New
204093	481 RRB Unemployment and Sickness Benefits Questionnaire Form and Instruction	New
204091	483 AMS MN Customer Satisfaction Survey Form and Instruction	New
204090	484 GSA Federal Supplier Greenhouse Gas Emissions Inventory Pilot Questionnaire Form and Instruction	New
204089	485 HRSA HAB Grantee Questionnaire Form and Instruction	New
204088	486 FEMA - BSB Printed Pubs Sat_Survey Form and Instruction	New
204087	487 FinCEN Compliance MOU Customer Survey Form and Instruction	New
204085	488 FinCEN Regulatory Resource Center Customer Survey Form and Instruction	New
204084	489 FinCEN Secure Outreach_WebCBRS Survey Form and Instruction	New
204083	490 Recreation Customer Service Survey Form and Instruction	New
204082	491 CMS Contractor Satisfaction Survey Form and Instruction	New
204081	492 PBGC Retiree Instrument Form and Instruction	New
204080	493 PBGC Participant Caller Instrument Form and Instruction	New
204079	494 HRSA NELRP and NSP 2012 Participant Questionnaire Form and Instruction	New
204078	495 DOJ JAG Questionnaire Form and Instruction	New
204077	496 PBGC Premium Filer Questionnaire Form and Instruction	New
204076	497 USCIS IO Questionnaire Form and Instruction	New
204075	498 FinCEN BSA E-Filing Survey Form and Instruction	New
204074	499 FINCEN Domestic Analytic Products Form and Instruction	New
204062	500 FINCEN Foreign Analytical Case Reports Form and Instruction	New
204061	501 FINCEN SAR Activity Review Form and Instruction	New
204060	502 HRSA BCRS NHSC Participant Survey Form and Instruction	New
204059	503 ED CFO Grantee Survey Form and Instruction	New
204058	504 FEMA Local Officials Questionnaire Form and Instruction	New
204057	505 FEMA General Public Survey Form and Instruction	New
204056	506 OCS Grantee Satisfaction Survey Form and Instruction	New
204055	507 RRB Survivor Customer Satisfaction Survey Form and Instruction	New
204054	508 SBA ODA Customer Satisfaction Survey Form and Instruction	New
204053	509 FAA Mechanics Customer Satisfaction Survey Form and Instruction	New
204052	510 FAA Carries Ops & Carriers Pilots Form and Instruction	New
204051	511 IRS LB&I Survey Form and Instruction	New
204050	512 IRS SBSE Survey Form and Instruction	New
204049	513 IRS Individual Filers Survey Form and Instruction	New
204048	514 E-Verity Customer Contact Center Form and Instruction	New
204047	515 HRSA BPHC Grantee Survey Form and Instruction	New
204046	516 FAA General Aviation Survey Form and Instruction	New
204045	517 NASA EOSDIS Questionnaire Form and Instruction	New
204044	518 DOJ COPS Survey Form and Instruction	New
204041	519 National Weather Service Form and Instruction	New
204040	520 State BCS Survey Form and Instruction	New
204039	520 Forest Service R&D Program Questionnaire Form and Instruction	New

ICR Details

OMB Control No: 1090-0007	ICR Reference No: 201209-1090-001
Status: Historical Active	Previous ICR Reference No: 200908-1090-001
Agency/Subagency: DOI/ASPMB	Agency Tracking No:
Title: American Customer Satisfaction Index "Customer Satisfaction Surveys"
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/05/2013
	Date Received in OIRA: 10/10/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	03/31/2013
Responses	131,250	0	112,500
Time Burden (Hours)	26,250	0	22,500
Cost Burden (Dollars)	0	0	0

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Abstract: The objectives of surveying citizen users of Federal Agencies as part of the American Customer Satisfaction Index are: (1) to make the agencies part of a national measure of customer satisfaction; (2) to benchmark against other agencies and companies; and (3) to provide information for improving customer satisfaction.

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Authorizing Statute(s): US Code: 31 USC 1116 Name of Law: Government Performance Results Act
   EO: EO 13450 Name/Subject of EO: Improving Government Program Performance
   EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
   EO: EO 13571 Name/Subject of EO: Streamlining Service Delivery and Improving Customer Service
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 12073	02/28/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 61623	10/10/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 113

IC Title	Form No.	Form Name
2015 687 FinCEN Portal_Query - 2015 692 NWS Quarterly Survey	688, 687, 690, 689, 691, 692	2015 688 Foreign FIU Survey ,   2015 687 FinCEN Portal Query Survey ,   2015 689 Resource Center Customer Survey ,   2015 690 AFI Grantee Satisfaction Survey Instrument ,   2015 691 USDA Rural Development Customer Satisfaction State Pilot ,   2015 692 NWS QuarterlySurvey Winter 2015
449 USDA NRCS Nutrient Management Program Survey	449	USDA NRCS Nutrient Management Program Survey
2013 523 HRSA HAB Grantee - 2013 524 FINCEN Portal_Query	524, 523	2013 523 HRSA HAB Grantee Questionnaire ,   2013 524 FinCEN Portal_Query
2014 660 SBA ODA Customer Satisfaction Survey - 2014 661 Department of Ed CFO Grantee Satisfaction Survey	660, 661	2014 660 SBA ODA Customer Satisfaction Survey ,   2014 661 Dept of ED CFO Grantee Satisfaction Questionnaire
498 FinCEN BSA E-Filing Survey	498	498 FinCEN BSA E-Filing Survey
494 HRSA NELRP and NSP 2012 Participant Questionnaire	494	494 HRSA NELRP and NSP Participant Questionnaire
438 HRSA BCRS NHSC 2011 Partner Questionnaire	438	438 HRSA BCRS NHSC Partner Questionnaire
389 Tricare Outpatient Survey	389	389 Tricare Outpatient Survey
501 FINCEN SAR Activity Review	501	FINCEN SAR Activity Review
368 GSA FCIC Customer Satisfaction Survey	368	368 GSA FCIC Customer Satisfaction Survey
520 Forest Service R&D Program Questionnaire	521	Forest Service R&D Program Questionnaire
455 E-Verify Enrollment Customer Satisfaction Survey	455	455 USCIS E-Verify Enrollment Customer Satisfaction Survey
2014 541 FEMA BSB Printed Pubs Sat Survey	541	2014 541 FEMA - BSB Printed Pubs Sat Survey
2013 531 HRSA Nurse Corp LRP and SP Critical Shortage Facilities - 2013 534 E-Verification Customer Satisfaction Survey	533, 532, 531, 534	2013 E-Verification Customer Satisfaction Survey ,   2013 531 HRSA Nurse Corp LRP and SP Critical Shortage Facilities ,   2013 532 NASA LANCE Questionnaire ,   2013 533 Customer Contact Center Survey E-Verify
2015 683 RRB Rail Employers Survey	683	2015 683 RRB Rail Employers Survey
480 US Mint Call Center Questionnaire	480	480 US Mint Call Center Questionnaire
477 NIST Ambulance Design	477	477 NIST Ambulance Design
357 CNCS Senior Corps Grantee Satisfaction Survey	357	357 CNCS Senior Corps Grantee Satisfaction Surve
495 DOJ JAG Questionnaire	495	495 DOJ JAG Questionnaire
492 PBGC Retiree Instrument	492	492 PBGC Retiree Instrument
430 VBA 2011 Call Center Questionnaire	430	430 VBA Call Center Questionnaire
511 IRS LB&I Survey	511	511 IRS LBI Survey
390 Tricare Inpatient Survey	390	390 Tricare Inpatient Survey
484 GSA Federal Supplier Greenhouse Gas Emissions Inventory Pilot Questionnaire	484	484 GSA Federal Supplier Greenhouse Gas Emissions Inventory
510 FAA Carries Ops & Carriers Pilots	510	510 FAA Carrier Ops - Air Carrier Pilots Survey
456 USDA Rural Development Questionnaire Rural Electrification Program	456	USDA Rural Developmetnt Questionnaire Rural Electrification
351 ED NCES Satisfaction Survey	351	351 ED NCES Satisfaction Survey
402 U.S. Mint Numismatic/Commemorative Coins Survey	402	402 U.S. Min Numismatic/Cmmemorative Coin Survey
2014 662 FinCEN Resource Center Customer Survey	662	2014 662 FinCEN Resource Center Customer Survey
2014 676 State Passport Services Survey	676	2014 676 State Passport Services Survey
663 2014 Local Officials Survey	663	2014 663 FEMA Local Official Questionnaire
2013 527 CMS MAC Questionniare - 2013 528 HRSA MCHB - MIECHV Questionnaire	527, 528	2013 527 CMS MAC Questionnaire FINAL ,   2013 528 HRSA MCHB - MIECHV Questionnaire
475 USCIS Asylum Customer Satisfaction Survey	475	475 USCIS Asylum Customer Satisfaction Survey
360 AmeriCorps NCCC Survey	360	360 AmeriCorps NCCC Satisfaction Survey
358 AmeriCorps State and National Grantees	358	358 AmeriCorps State and National Grantees
512 IRS SBSE Survey	512	512 IRS SBSE Survey
496 PBGC Premium Filer Questionnaire	496	496 PBGC Premium Filer Questionnaire
490 Recreation Customer Service Survey	490	490 Rec.gov Call Center
413 U.S. Mint Collectible Coins Survey	413	413 U.S. Mint Collectible Coins Survey
381 VA VHA Outpatient Survey	381	381 VA VHA Outpatient Survey
515 HRSA BPHC Grantee Survey	515	515 HRSA BPHC Grantee Survey
509 FAA Mechanics Customer Satisfaction Survey	509	509 FAA Mechanics Customer Satisfaction Survey
520 State BCS Survey	520	520 State BCS Survey
298 HRSA MCHB Resource Center Satisfaction Survey	298	298 HRSA MCHB Resource Center Questionnaire
342 SEC OIEA Jul 2010 Questionnaire Call Cente	342	342 SEC OIEA Call Center Questionnaire
2014 545 VA OI&TContinuous Survey (Large) - 2014 547 VA OI&T Continuous Survey (Small)	545, 546, 547	2014 545 VA OI&T Continuous Survey - Large ,   2014 546 VA OI&T Continuous Survey - Medium ,   2014 547 VA OI&T Continuous Survey - Small
2013 529 FinCEN Domestic Analytic Products Survey - 2013 530 NASA EOSDIS Questionnaire	530, 529	2013 529 FInCEN Domestic Analytic Products Survey ,   2013 530 NASA EOSDIS Questionnaire
2014 539 FinCEN BSA E-Filing Customer Survey - 2014 540 FinCEN Compliance MOU Customer Survey	540, 539	2014 FinCEN BSA E-Filing Customer Survey ,   2014 540 FinCEN Compliance MOU Customer Survey
497 USCIS IO Questionnaire	497	497 USCIS International Operations Survey
429 VBA Insurance Claims Questionnaire	429	429 VBA Insurance Claims Questionnaire
444 Social Security Administration Call Center Questionnaire	444	444 Social Security Administration Call Center Questionnaire
409 VHA Champ VA Questionnaire	409	409 VHA Champ VA Questionnaire
508 SBA ODA Customer Satisfaction Survey	508	508 SBA ODA Customer Satisfaction Survey
505 FEMA General Public Survey	505	505 FEMA Public Questionnaire
488 FinCEN Regulatory Resource Center Customer Survey	488	488 FinCEN Regulatory Resource Center Customer Survey
451 FAA Manufacturers Questionnaire	451	451 FAA Manufacturers Questionnaire
335 GSA State and Local Programs Survey	335	335 GSA State and Local Programs Survey
519 National Weather Service	519	519 NWS Survey Final 8-27-12
2015 682 NASS Customer Satisfaction Survey Final	682	2015 682 NASS Customer Satisfaction Survey Final
2014 675 NWS_General	675	2014 675 NWS_General
2013 535 ACSI CHAMPVA Questions - 2013 537 ACSI SB Questions	535, 536, 537	2013 535 ACSI CHAMPVA Questions ,   2013 536 ACSI FMP Questions ,   2013 537 ACSI SB Questions
2014 556 PBGC Premium Filer Questionnaire - 2014 559 LBI ACSI Questionnaire	556, 557, 558, 559	LBI ACSI Questionaire ,   2014 556 PBGC Premium Filer Questionnaire ,   2014 557 SBSE ACSI Questionnaire ,   2014 558 WI ACSI Questionnaire
499 FINCEN Domestic Analytic Products	499	499 FinCEN Domestic Analytic Products Survey
380 VA VHA Inpatient Survey	380	380 VA VAH Inpatient Survey
504 FEMA Local Officials Questionnaire	504	504 FEMA Local Officials Questionnaire
483 AMS MN Customer Satisfaction Survey	483	483 AMS MN Customer Satisfaction Survey
356 CNCS Learn and Serve America Grantees	356	356 CNCS Learn and Serve America Grantee Satisfaction
516 FAA General Aviation Survey	516	FAA General Aviation Survey
507 RRB Survivor Customer Satisfaction Survey	507	507 RRB Survivor Customer Satisfaction Survey
506 OCS Grantee Satisfaction Survey	506	506 OCS Grantee Satisfaction Survey
454 USDA RD FINAL Questionnaire RCD Grant RBS	454	454 USDA RD RCD Grant RBS Survey
470 USDA Rural Development Questionnaire Rural Housing and Community Facilities Loans	470	470 USDA Rural Development Questionnaire Rural Housing and Community Facilities
2013 538 Final NCES Questionniare	538	2013 538 Final NCES Questionnaire
2014 680 VHAOutpatient Survey = 2014 681 VHA Inpatient Survey	681, 680	2014 681 VHAInpatient Survey ,   2014 680 VHAOutpatient Survey
2014 678 E-Verification Customer Satisfaction Survey	678	2014 678 E-Verification Customer Satisfaction Survey
664 NWS_Internet_Panel - 672 USDA FSIS Call Center	664, 665, 666, 667, 668, 669, 670, 671, 672	2014 664 NWS InternetPanel DCY ,   2014 665 Customer Contact Center E-Verify ,   2014 666 Department of Ed Call Center Questionnaire ,   2014 667 FTC Questionnaire ,   2014 Recreation Customer Service Survey ,   2014 669 SEC OIEA Questonnaire Email ,   2014 SEC OIEA Questionnaire IVR ,   2014 671 US Mint Call Center Questionnaire ,   2014 672 USDA FSIS Call Center Questionnaire
2014 673 HRSA BPHC Health Care Program Survey - 2014 674 EOSDIS Questionnaire	673, 674	2014 673 HRSA BPHC Health Center Program Survey ,   2014 674 EOSDIS Questionnaire
359 CNCS Vista Program Survey	359, 359	359 CNCS Vista Program Satisfaction Survey ,   359 CNCS Vista Program Survey
493 PBGC Participant Caller Instrument	493	493 PBGC Participant Caller Instrument
410 DOJ COPS TTA Recipients Quarterly	410	410 DOJ COPS TTA Recipient Quarterly Survey
489 FinCEN Secure Outreach_WebCBRS Survey	489	489 FinCEN Secure Outreach WebCBRS Survey
487 FinCEN Compliance MOU Customer Survey	487	487 FinCEN Compliance MOU Customer Survey
367 NCA Customer Satisfaction Survey	367	367 NCA Customer Satisfaction Survey
450 FAA Carriers Ops Mgt Questionnaire	450	450 FAA Carriers Ops Mgmt Questionnaire
391 UDSA Rural Development Survey Water-B&I-Multifamily	391	391 UDSA Rural Development Survey Water-B&I-Multifamily
502 HRSA BCRS NHSC Participant Survey	502	HRSA BCRS NHSC Participant Survey
2014 542 PBGC Retiree Instrument - 2014 543 PBGC Participant Caller Instrument	542, 543	2014 542 PBGC Retiree ACSI Instrument ,   2014 543 PBGC Partcipant Caller ACSI Instrument
2014 544 HRSA HAB Grantee Questionnaire	544	2014 544 HRSA HAB Grantee Questionnaire
2014 679 NASA LANCE Questionnaire	679	2014 679 NASA LANCE Questionnaire
2013 525 HRSA Nurse Corp LRP and SP	525	2013 525 HRSA Nurse Corp LRP and SP 2013 Participant Questionnaire
2015 684 FinCENC BSA E-Filing Customer Survey - 2015 686 Domestic Analytic Products Survey	686, 684, 685	2015 684 FinCEN BSA E-Filing Customer Survey ,   2015 685 FinCEN Complilance MOU Customer Survey ,   2015 686 Domestic Analytic Products Survey
423 DOJ COPS Monthly Publication Survey	423	423 DOJ COPS Monthy Publication Survey
500 FINCEN Foreign Analytical Case Reports	500	500 FINCEN Foreign Case Reports Questionnaire
485 HRSA HAB Grantee Questionnaire	485	485 HRSA HAB Grantee Questionnaire
376 AFI Grantee Satisfaction Survey	376	376 AFI Grantee Satisfaction Survey
375 DTIC Customer Satisfaction Survey	375	375 DTIC Customer Satisfaction Survey
518 DOJ COPS Survey	518	Annual DOJ COPS Survey
517 NASA EOSDIS Questionnaire	517	517 NASA EOSDIS Questionnaire
2014 677 USDA Forest Service RD Customer Satisfaction Questionnaire	677	2014 677 USDA Forest Service RD Customer Satisfaction Questionnaire
2014 549 NHSC Participant Questionnaire - 2014 550 Nurse Corps Participant Questionnaire	550, 549	2014 NURSE Corps Participant Questionnaire ,   2014 549 NHSC Participant Questionnaire
2013 526 NHSC Participant Questionnaire	526	2013 526 NHSC 2013 Participant Questionnaire Final
522 PBGC Participant Caller	522	2013 522 PBGC Particpant Caller
481 RRB Unemployment and Sickness Benefits Questionnaire	481	481 RBB Unemployment and Sickness Benefits Questionnaire
491 CMS Contractor Satisfaction Survey	491	491 CMS Contractor Satisfaction Survey
403 USDA FAS Survey	403	403 USDA FAS Survey
513 IRS Individual Filers Survey	513	IRS Individual Filers Survey
503 ED CFO Grantee Survey	503	503 ED CFO Grantee Questionnaire
486 FEMA - BSB Printed Pubs Sat_Survey	496	496 FEMA BSB Printed Pubs Sat Survey
514 E-Verity Customer Contact Center	514	514 E-Verify Customer Contact Center Surey
329 FAA ATO Satisfaction Survey	329	329 FAA ATO Satisfaction Survey
452 FAA Repair Station Questionnaire	452	452 FAA Repair Station Questionnaire
353 EEOC Contact Center Customer Satisfaction Survey	353	353 EEOC Contact Center Customer Satisfaction Survey
551 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2014 555 FAA Air Traffic Control Organization Quarterly FSS Survey	551, 552, 553, 554, 555	2014 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire ,   2014 552 Foreign FIU Survey ,   2014 553 Domestic Analytic Products Survey ,   2014 554 FinCEN Portal Query Survey ,   2014 555 FAA Air Traffic Control Organization FSS quarterly survey

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ICR Summary 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	131,250	112,500	0	18,750	0	0
Annual Time Burden (Hours)	26,250	22,500	0	3,750	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Overall burden has increased because more data collection is conducted online and the number of responses has increased per survey.

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Annual Cost to Federal Government: $4,948,003

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/10/2012

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