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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

EBSA 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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.