Customer Feedback Survey of 2015 EIS Conference

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

Documents and Forms

Document Name Document Type
Customer Feedback Survey of 2015 EIS Conference Form
2015 EIS Conference Survey Att_2_Customer_Service_Feedback_Survey_Screenshots.docx Form
2015 EIS Conference Survey Att_1_2015 EIS Conf Customer_Service_Survey.docx Form
Post Conference Flyer02212015_blank.pdf Survey Flyer IC Document
GenIC_Request_2015_EIS_Conf_20150212.docx Request for Approval IC Document
2015 EIS Conf Cust Survey_New Requirements_Final.docx Request Summary IC Document
Att_4_Invitation Email.docx Invitation email IC Document
Att_5_Reminder_Email.docx Reminder email IC Document

Information Collection (IC) Details

IC Title:	Customer Feedback Survey of 2015 EIS Conference	Agency IC Tracking Number:	15PH

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	2015 EIS Conference Survey	Att_2_Customer_Service_Feedback_Survey_Screenshots.docx		Yes	Yes	Fillable Fileable
Form	none	2015 EIS Conference Survey	Att_1_2015 EIS Conf Customer_Service_Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	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	2,000	2,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey Flyer	Post Conference Flyer02212015_blank.pdf	02/23/2015
Request for Approval	GenIC_Request_2015_EIS_Conf_20150212.docx	02/23/2015
Request Summary	2015 EIS Conf Cust Survey_New Requirements_Final.docx	02/23/2015
Invitation email	Att_4_Invitation Email.docx	02/23/2015
Reminder email	Att_5_Reminder_Email.docx	02/23/2015

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