ATSDR Customer Satisfaction Survey for DCHI Documents

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Document Name Document Type
ATSDR Customer Satisfaction Survey for DCHI Documents Form
ATSDR Customer Satisfaction Survey for DCHI Documents (o AttC. ATSDR Customer Satisfaction Survey for DCHI Documents (text).docx Form
ATSDR Customer Satisfaction Survey for DCHI Documents (o AttB. ATSDR Customer Satisfaction Survey for DCHI Documents (on-line).docx Form
AttA Email Invitation for ATSDR Customer Satisfaction Survey for DCHI Documents.docx AttA Email Invitation for ATSDR Customer Satisfaction Survey for DCHI Documents IC Document
0923-0047 Gen_Clearance_Customer_Feedback_DCHI_Custmr_Satisfctn 20130829.pdf 0923-0047 Gen_Clearance_Customer_Feedback_DCHI_Custmr_Satisfctn 20130829 IC Document

Information Collection (IC) Details

IC Title:	ATSDR Customer Satisfaction Survey for DCHI Documents	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	None	ATSDR Customer Satisfaction Survey for DCHI Documents (on-line)	AttC. ATSDR Customer Satisfaction Survey for DCHI Documents (text).docx		Yes	Yes	Fillable Fileable
Form	None	ATSDR Customer Satisfaction Survey for DCHI Documents (on-line)	AttB. ATSDR Customer Satisfaction Survey for DCHI Documents (on-line).docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	1,000	0	0	0	0	0
Annual IC Time Burden (Hours)	83	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
AttA Email Invitation for ATSDR Customer Satisfaction Survey for DCHI Documents	AttA Email Invitation for ATSDR Customer Satisfaction Survey for DCHI Documents.docx	09/06/2013
0923-0047 Gen_Clearance_Customer_Feedback_DCHI_Custmr_Satisfctn 20130829	0923-0047 Gen_Clearance_Customer_Feedback_DCHI_Custmr_Satisfctn 20130829.pdf	09/06/2013

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