Customer input survey for development of an IMLS web-based evaluation tool

Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3137-0081 can be found here:

Documents and Forms

Document Name Document Type
Form Form No1 Customer input survey for development of an IMLS web-based evaluation tool Form and Instruction
Form No1 IMLS Survey 141204 Generic Clearance - OMB No 3137-0081 SI Project.doc si.az1.qualtrics.com/SE/?SID=SV_0As0xm5TR9xqj8F Form and Instruction
Reporting Burden Estimate SI.xlsx SI Project Burden IC Document
Generic Clearance - OMB No 3137-0081 SI Project.doc Generic Clearance - OMB No 3137-0081 SI Project IC Document

Information Collection (IC) Details

IC Title:	Customer input survey for development of an IMLS web-based evaluation tool	Agency IC Tracking Number:

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 and Instruction	Form No1	IMLS Survey 141204	Generic Clearance - OMB No 3137-0081 SI Project.doc	http://si.az1.qualtrics.com/SE/?SID=SV_0As0xm5TR9xqj8F	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	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
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	4,220	4,220

Documents for IC

Title	Document	Date Uploaded
SI Project Burden	Reporting Burden Estimate SI.xlsx	12/05/2014
Generic Clearance - OMB No 3137-0081 SI Project	Generic Clearance - OMB No 3137-0081 SI Project.doc	12/05/2014

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