Information Collection

One-Time Customer Satisfaction Survey

IC 210765 under ICR 201403-0920-007 · OMB 0920-0138.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0138 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
One-Time Customer Satisfaction Survey	Form
Customer Survey Attachment 8 (2).docx	Form

IC Title:

One-Time Customer Satisfaction Survey

Agency IC Tracking Number:

Is this a Common Form? No

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	none	Customer Survey	Attachment 8 (2).docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23

Number of Respondents for Small Entity: 6

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	23	23
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.