Information Collection

Field Representative Exit Questionnaire/Decennial Field Staff Exit Questionnaire

IC 3428 under ICR 201212-0607-001 · OMB 0607-0404.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BC1294 Changes 12-2011.doc	Other-Proposed Changes to BC-1294
BC-1294(D) Decennial Field Staff Exit Questionnaire BC-1294(D) (05-06-09).pdf	Form
BC-1294 Field Representative Exit Questionnaire bc1294.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Other-Proposed Changes to BC-1294			BC1294 Changes 12-2011.doc	No	Paper Only
Form	BC-1294(D)	Decennial Field Staff Exit Questionnaire	BC-1294(D) (05-06-09).pdf	No	Paper Only
Form	BC-1294	Field Representative Exit Questionnaire	bc1294.pdf	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 650

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	650	650
Annual IC Time Burden (Hours)	84	84
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.