Information Collection

EBSA Participant Assistance Program Customer Survey

IC 219180 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
US_DOL_EBSA_2016_Q1_CE3_Outbound_2015 10 06 09 57.docx Other-Telephone Survey
Revised OMB Part A Revision for FY15 Q3 Survey cuts.docx OMB Supporting Statement Part A IC Document
OMB Part B.docx OMB Supporting Statement Part B IC Document
EBSA_Customer Survey Signed Approval.pdf OCEO Statistical Method Approval IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	EBSA Participant Assistance Program Customer Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Telephone Survey			US_DOL_EBSA_2016_Q1_CE3_Outbound_2015 10 06 09 57.docx		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,000	11,000
Annual IC Time Burden (Hours)	1,467	1,467
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Supporting Statement Part A	Revised OMB Part A Revision for FY15 Q3 Survey cuts.docx	12/04/2015
OMB Supporting Statement Part B	OMB Part B.docx	12/04/2015
OCEO Statistical Method Approval	EBSA_Customer Survey Signed Approval.pdf	12/04/2015

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