Information Collection

Jac And Jaccis Customer Satisfaction Survey

IC 217903 under ICR 201410-1601-003 · OMB 1601-0014.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1601-0014 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 0041 JAC AND JACCIS CUSTOMER SATISFACTION SURVEY	Form
DHS Form 0041 JAC Survey DHS Form 0041-JAC Survey.pdf	Form
JAC Satisfaction Generic Clearance Submission.docx Generic IC submission form	IC Document
JAC Survey Email Cover Letter.docx Email to Respondents	IC Document

IC Title:

JAC AND JACCIS CUSTOMER SATISFACTION SURVEY

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DHS Form 0041	JAC Survey	DHS Form 0041-JAC Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

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	750	750
Annual IC Time Burden (Hours)	188	188
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic IC submission form	JAC Satisfaction Generic Clearance Submission.docx	08/20/2015
Email to Respondents	JAC Survey Email Cover Letter.docx	08/20/2015

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