Information Collection

ATSDR Customer Satisfaction Survey

IC 214299 under ICR 201305-0923-003 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0923-0047 ATSDR Customer Satisfaction Survey	Form and Instruction
0923-0047 AttA Script for ATSDR Customer Satisfaction Survey AttA Script for ATSDR Customer Satisfaction Survey.docx	Form and Instruction
0923-0047 AttB ATSDR Customer Satisfaction Survey Questionnaire AttB ATSDR Customer Satisfaction Survey Questionnaire.docx	Form and Instruction
AttC Wrksht2 ATSDR Customer Satisfaction Survey.docx AttC Wrksht2 ATSDR Customer Satisfaction Survey	IC Document
0923-0047 GenIC ATSDR Customer Satisfaction Survey.pdf 0923-0047 GenIC ATSDR Customer Satisfaction Survey	IC Document

IC Title:

ATSDR Customer Satisfaction Survey

Agency IC Tracking Number:

15IF

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
Form and Instruction	0923-0047	AttA Script for ATSDR Customer Satisfaction Survey	AttA Script for ATSDR Customer Satisfaction Survey.docx		No		Fillable Printable
Form and Instruction	0923-0047	AttB ATSDR Customer Satisfaction Survey Questionnaire	AttB ATSDR Customer Satisfaction Survey Questionnaire.docx		No		Fillable Printable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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	2,000	2,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
AttC Wrksht2 ATSDR Customer Satisfaction Survey	AttC Wrksht2 ATSDR Customer Satisfaction Survey.docx	12/17/2014
0923-0047 GenIC ATSDR Customer Satisfaction Survey	0923-0047 GenIC ATSDR Customer Satisfaction Survey.pdf	12/17/2014

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