Information Collection

Survey - Consumer Advisory Board Member

IC 204967 under ICR 201211-3170-001 · OMB 3170-0037.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0037 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3170-XXXX Survey - Consumer Advisory Board Member	Form and Instruction
3170-XXXX Consumer Advisory Board Member Survey Survey-Consumer Advisory Board Member [FINAL].pdf	Form and Instruction

IC Title:

Survey - Consumer Advisory Board Member

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	3170-XXXX	Consumer Advisory Board Member Survey	Survey-Consumer Advisory Board Member [FINAL].pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	17	17
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.