VetoViolence Online Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1009 can be found here:

Documents and Forms

Document Name Document Type
VetoViolence Online Survey Form
VetoViolence Survey VetoViolence survey_SurveyMonkey_030315.pdf Form
Request GenIc1009 VetoViolence_RM 030315.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	VetoViolence Online Survey	Agency IC Tracking Number:	15RZ

IC Status: New

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	none	VetoViolence Survey	VetoViolence survey_SurveyMonkey_030315.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

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)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Request GenIc1009 VetoViolence_RM 030315.docx	03/05/2015

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