Information Collection

Public Engagement Platform Surveys

IC 212169 under ICR 201406-0930-006 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Bulling Prevention Public Engagement Platform Surveys	Form and Instruction
Bulling Prevention Bulling Prevention Survey Attachment 1_Bullying Prevention.docx	Form and Instruction
Suicide Prevention Suicide Prevention Survey Attachment 2_Suicide Prevention.docx	Form and Instruction
Contact Center Sur Contact Center Survey Attachment 3_contact center.docx	Form and Instruction
Customer Feedback Surveys OMB Request 6-27-14.doc Justification	IC Document
Trans.Let-1-2014.doc Transmittal Letter	IC Document

IC Title:

Public Engagement Platform Surveys

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Bulling Prevention Survey	Bulling Prevention Survey	Attachment 1_Bullying Prevention.docx	Yes	Yes	Fillable Printable
Form and Instruction	Suicide Prevention Survey	Suicide Prevention Survey	Attachment 2_Suicide Prevention.docx	Yes	Yes	Fillable Printable
Form and Instruction	Contact Center Survey	Contact Center Survey	Attachment 3_contact center.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 888

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	888	888
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	Customer Feedback Surveys OMB Request 6-27-14.doc	06/30/2014
Transmittal Letter	Trans.Let-1-2014.doc	06/30/2014

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