American Community Survey Customer Feedback

Generic Clearance for Data User and Customer Evaluation Surveys

Documents and Forms

Document Name Document Type
Form American Community American Community Survey Customer Feedback Form and Instruction
American Community American Community Survey Customer Feedback DataOrSurveyUser_revised.pdf Form and Instruction
American Community American Community Survey Customer Feedback InitialScreen_revised.pdf Form and Instruction
American Community American Community Survey Customer Feedback Neither_revised.pdf Form and Instruction
ACSO_omb_clearance_request_form.docx Memo IC Document
ACSO_omb_clearance_request_form_rev.docx ACSO_omb_clearance_memo_rev IC Document

Information Collection (IC) Details

IC Title:	American Community Survey Customer Feedback	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	American Community Survey Customer Feedback	American Community Survey Customer Feedback	DataOrSurveyUser_revised.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	American Community Survey Customer Feedback	American Community Survey Customer Feedback	InitialScreen_revised.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	American Community Survey Customer Feedback	American Community Survey Customer Feedback	Neither_revised.pdf	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Memo	ACSO_omb_clearance_request_form.docx	08/01/2016
ACSO_omb_clearance_memo_rev	ACSO_omb_clearance_request_form_rev.docx	08/18/2016

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