Customer Assessment Survey

Voluntary Customer Surveys in Accordance with E.O. 12862

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0192 can be found here:

Documents and Forms

Document Name Document Type
Form G-201 (08-03) Customer Assessment Survey Form and Instruction
G-201 (08-03) Customer Assessment Survey G-201 (08-03).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Customer Assessment 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
Form and Instruction	G-201 (08-03)	Customer Assessment Survey	G-201 (08-03).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 180

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.