Information Collection

Survey form

IC 214184 under ICR 201403-1028-003 · OMB 1028-0112.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey form	Form and Instruction
Instrument Questionnaire 2015-02-04.pdf	Form and Instruction

IC Title:

Survey form

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 and Instruction	NA	NA	Instrument Questionnaire 2015-02-04.pdf		Yes	Yes	Fillable Fileable

Line of Business: Natural Resources

Subfunction: Water Resource Management

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	300	300
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.