Information Collection

American Community Survey Customer Feedback

IC 222783 under ICR 201403-0607-004 · OMB 0607-0760.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.