Information Collection

ANA Services Feedback Survey

IC 206311 under ICR 201211-0970-002 · OMB 0970-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0401 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ANA Services Feedback Survey	Form and Instruction
1 ANA Services Feedback Survey ANA Services Survey-JCM.doc	Form and Instruction
Fast-Track-PRA-Submission-Short-Form JCM.doc Request for Approval	IC Document

IC Title:

ANA Services Feedback Survey

Agency IC Tracking Number:

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	ANA Services Feedback Survey	ANA Services Survey-JCM.doc		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	100	0	0	0	0	0
Annual IC Time Burden (Hours)	50	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Fast-Track-PRA-Submission-Short-Form JCM.doc	03/29/2013

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