Information Collection

Employee Benefits Security Administration Participant Assistance Program Customer Survey

IC 207869 under ICR 201304-1225-001 · OMB 1225-0059.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0059 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
US_Department_of_Labor_-_EBSA_CE11_1210_Outbound_2013 .docx	Other-CATI Survey Instrument
Employee Benefits Security Administration Participant Assistance Program Customer Survey Supplemental Supporting Statement(20130724).docx Employee Benefits Security Administration Participant Assistance Program Customer Survey Justification	IC Document
CEO Approval.pdf Office of the Chief Evaluation Officer Approval	IC Document

IC Title:

Employee Benefits Security Administration Participant Assistance Program Customer 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
Other-CATI Survey Instrument			US_Department_of_Labor_-_EBSA_CE11_1210_Outbound_2013 .docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,380

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,380	6,380
Annual IC Time Burden (Hours)	851	851
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Employee Benefits Security Administration Participant Assistance Program Customer Survey Justification	Employee Benefits Security Administration Participant Assistance Program Customer Survey Supplemental Supporting Statement(20130724).docx	07/24/2013
Office of the Chief Evaluation Officer Approval	CEO Approval.pdf	07/23/2013

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