Information Collection

e-Communications Recipient

IC 197113 under ICR 201403-0930-006 · OMB 0930-0325.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0325 can be found here:

Documents and Forms

Document Name Document Type
Form Customer Satisfact e-Communications Recipient Form and Instruction
Customer Satisfact Customer Satisfaction Survey Attachment B1 Customer Satisfaction Survey.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	e-Communications Recipient	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	Customer Satisfaction Survey	Customer Satisfaction Survey	Attachment B1 Customer Satisfaction Survey.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	300	50	250
Annual IC Time Burden (Hours)	75	12	63
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.