Information Collection

Portland Area Division of Environmental Health Services: Customer Service Assessment

IC 206923 under ICR 201301-0917-001 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0036-21 OMB No 0917-0036-21, Portland Area Division of Environmental Health Services: Customer Services Assessment Portland Area Division of Environmental Health Services: Customer Service Assessment	Form and Instruction
0917-0036-21 OMB No 0917-0036-21, Portland Area Division of Environme OMB No. 0917-0036-21, Portland Area Division of Environmental Health Services Customer Services Assessment.pdf	Form and Instruction
OMB No. 0917-0036-21, Mini Supporting Statement for Portland Area DEHS Customer 5-7-13.pdf 0MB No. 0917-0036-21, Mini-Supporting Statement for PAO DEHS: Customer Service Assessment	IC Document

IC Title:

Portland Area Division of Environmental Health Services: Customer Service Assessment

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	0917-0036-21				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0MB No. 0917-0036-21, Mini-Supporting Statement for PAO DEHS: Customer Service Assessment		05/07/2013

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

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