American Customer Satisfaction Index "Customer Satisfaction Surveys"

Forms and Documents

Document Name	Status
Form 019 CMS PCG Customer Satisfaction Survey Form and Instruction	New
Form 018 SBA ODA Customer Service Survey Form and Instruction	New
Form 017 USDA Market News Form and Instruction	New
Form 016 Nurse Corps Participant Survey Form and Instruction	New
Form 015 NHSC Participant Survey Form and Instruction	New
Form 014 2018 014 WI ACSI Questionnaire Form and Instruction	New
Form 013 2018 013 SBSE ACSI Questionnaire Form and Instruction	New
Form 007 2018 012 LBI ACSI Questionnaire Form and Instruction	New
Form 005 2018 005 VA MOVE! Patient Experience Survey 2018_FINAL_3-23-18 -updated 6-22-18 Form and Instruction	New
Form 011 2018 011 Dept of ED CFO Grantee Questionnaire_to OMB_6.19.18 Form and Instruction	New
Form 007 NASA Earthdata Survey Form and Instruction	New
Form 008 FinCEN Regulatory Resource Center Survey Form and Instruction	New
Form 007 2018 007 Questionnaire_NPS.gov_Final Draft (1) Form and Instruction	New
Form 006 2018 006 Foreign FIU Survey_to OMB Form and Instruction	New
Form 004 2018 004 Retiree ACSI Instrument 2018 Form and Instruction	New
Form 004 2018 004 FinCEN BSA E-Filing Customer Survey 2018_FINAL Form and Instruction	New
Form 003 2018 003 FinCEN Portal_Query Survey FINAL Form and Instruction	New
Form 002 2018 002 FinCEN Compliance MOU Customer Survey 2018_FINAL_to OMB Form and Instruction	New
Form 002 2018 002 Products and Services_2018_FINAL Form and Instruction	New
Form 838 2017 838 USCIS Welcome Booklet Survey_to OMB 12-14 Form and Instruction	New
Form 836 2017 836 NPS CSP - Satisfaction Pilot Questionnaire Draft to FCG Form and Instruction	New
Form 837 2017 837 NCES Questionnaire 2017_to OMB Form and Instruction	New
Form 835 2017 835 PBGC Premium Filer Questionnaire 2018_FINAL to OMB Form and Instruction	New
Form 834 2017 834 B CA Call Center Survey 2017 v3.0 Spanish Form and Instruction	New
Form 833 2017 833 ACSI E-Verify Questionnaire 20171102 to OMB Form and Instruction	New
Form 832 2017 832 Benefits.gov - WebMonitor Questionniare - Final Form and Instruction	New
Form 831 2017 831 SBA survey v5.0 Form and Instruction	New
Form 830 2017 830 Spina Bifida Survey 2017 v2 Form and Instruction	New
Form 829 2017 829 CHAMPVA Survey 2017 v2 Form and Instruction	New
Form 828 2017 828 BCA Call Center Survey 2017 v3.1 Form and Instruction	New
Form 826 2017 826 VHA_Outpatient 2017 Survey to OMB Form and Instruction	New
Form 827 2017 827 VHA_Inpatient 2017 Survey to OMB Form and Instruction	New
Form 825 2017 825 OCS_CSBG_ACSI Survey of States_2017 Instrument_v2 to OMB Form and Instruction	New
Form 824 2017 824 FY18Q1_PopupSurvey_Clean_FINAL_091117_to OMB Form and Instruction	New
Form 823 2017 823 CSSurvey Questionnaire 2018_v4 Form and Instruction	New
Form 822 2017 822 Questionnaire_USGS Webmonitor_CFI Group Final_8.24.17 Form and Instruction	New
Form 821 2017 821 EOSDIS Questionnaire - Combined updated v2 clean Form and Instruction	New
Form 820 2017 820 ACSI Survey Questions_BCA Passport (Final Aug 16 2017) Form and Instruction	New
Form 819 2017 819 SBA ODA Customer Satisfaction Survey 2017_FINAL_20170815 Form and Instruction	New
Form 818 2017 818 NURSE Corps Participant Satisfaction Survey - Updated_20170718-CLEA... Form and Instruction	New
Form 817 2017 817 NHSC Site Satisfaction Survey - Updated_20170718-CLEAN Form and Instruction	New
Form 816 2017 816 NHSC Participant Satisfaction Survey - Updated_20170718-CLEAN Form and Instruction	New
Form 815 2017 815 BPHC 2017 Stakeholder Satisfaction Survey Questionnaire.v2 Form and Instruction	New
Form 814 2017 814 HRSA Grantee Satisfaction Survey - 6-16-17 Final Form and Instruction	New
Form 813 2017 813 FEMA HMA Survey Draft 6-20-17 V3.2 Form and Instruction	New
Form 810 2017 810 WI ACSI Questionnaire - 5.31 Form and Instruction	New
Form 812 2017 812 SBSE ACSI Questionnaire - 5.31 Form and Instruction	New
Form 811 2017 811 LBI ACSI Questionnaire -5.31 Form and Instruction	New
Form 809 2017 809 Resource Center Customer Survey_to OMB Form	New
Form 804 2017 804 FinCEN Domestic Analytic Products Survey_to OMB (1) Form and Instruction	New
Form 805 2017 805 FinCEN BSA E-Filing Customer Survey 2017_to OMB Form and Instruction	New
Form 806 2017 806 FinCEN Compliance MOU Customer Survey 2_1_16 to OMB Form and Instruction	New
Form 807 2017 807 FinCEN Portal_Query Survey_to OMB Form and Instruction	New
Form 808 2017 808 Foreign FIU Survey_to OMB Form and Instruction	New
Form 803 2017 803 Dept of ED CFO Grantee Questionnaire_to OMB Form and Instruction	New
Form 802 2017 802 E-Verify CCO Survey_2017 Proposed Revisions_20170315_c Form	New
Form 801 2017 801 MSI Questionnaire_CMS Final _Approved 3-3-17 Form and Instruction	New
Form 796 2016 796 Questionaire _CRT_Webmonitor _CFI -Draft-1.5 Form	New
Form 795 2016 795 Questionnaire_climate.gov_CFI-Draft-1.3 Form	New
Form 794 2016 794 DOE_WAP_ACSI Survey of Local Agencies_2016 Form	New
Form 793 2016 793 NPS Contracting Office Customer Satisfaction Survey_Final to OMB Form and Instruction	New
Form 793 2016 793 DOI OST Beneficiaries Questionaire_Final Form and Instruction	New
Form 792 2016 792 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2016- OMB submission Form	New
Form 791 2016 791 ACSI E-Verify Questionnaire initial draft with USCIS CFI edits 20160510_NR changes accepted (1) Form	New
Form 790 2016 790 HRSA HAB Grantee Questionnaire - 2016 Final Edits for CFI RR Final Edits 9-26-16 OMB review Form	New
Form 789 2016 789 VHA_Outpatient 2016 Survey Form	New
Form 788 2016 788 VHA_Inpatient 2016 Survey Form	New
Form 787 2016 787 DOE_WAP_ACSI Survey of States_Grantees_2016 Questionnaire_Final Form	New
Form 786 2016 786 DOI OST Call Center Questionnaire - Final Form	New
Form 785 2016 785 EOSDIS Questionnaire Form	New
Form 784 2016 784 NASA LANCE Questionnaire Form	New
Form 783 2016 783 SBA ODA Customer Satisfaction Survey 2016_FINAL Form and Instruction	New
Form 782 2016 782 NHSC 2016 Participant Questionnaire _FINAL_20160721 Form and Instruction	New
Form 781 2016 781 NURSE Corps 2016 Participant Questionnaire_FINAL_20160721 Form	New
Form 780 2016 780 WI ACSI Questionnaire - 7.11.2016 Form and Instruction	New
Form 779 2016 779 SBSE ACSI Questionnaire - 7.11.2016 Form and Instruction	New
Form 778 2016 778 LBI ACSI Questionnaire - 7.11.2016 Form and Instruction	New
Form 777 2016 777 BCA Passport Survey FINAL_ to OMB Form and Instruction	New
Form 776 2016 776 BPHC 2016 Stakeholder Satisfaction Survey Questionnaire Final Form and Instruction	New
Form 776 2016 776 Resource Center Customer Survey_final_to OMB Form	New
Form 775 2016 775 FAA Website Questionnaire - Final - 5.6.16 Form and Instruction	New
Form 775 2016 775 Foreign FIU Survey_v1_clean Form	New
Form 774 2016 774 MSI Questionnaire Final 04062016 Form	New
Form 773 2015 773 FinCEN Portal_Query Survey_to OMB Form	New
Form 772 2015 772 FinCEN Domestic Analytic Products Survey to OMB Form	New
Form 771 2015 771 Dept of ED CFO Grantee Questionnaire CORE + ALL CUSTOM_Final Form	New
Form 770 2015 770 5ACSI E-Verify Questionnaire for OBM clearance Form	New
Form 769 2015 769 FinCEN BSA E-Filing Customer Survey 2016_to OMB Form	New
Form 768 2015 768 FEMA - BSB Printed Pubs Sat Survey_v0_20151124 Form	New
Form 767 2015 767 HRSA Grantee Satisfaction Survey_for CFI FCG v2 Form	New
Form 766 2015 766 GSA WebMonitor Questionnaire - Final Form	New
Form 765 2015 765 FinCEN Compliance MOU Customer Survey 2_25_16 Form	New
Form 764 2015 764 NCA_Questionnaire_2016 (same as last year) Form	New
Form 764 2015 764 NCA_Questionnaire_2016 (same as last year) Form	New
Form 763 2015 763 USDA New Farmers Program - Customer Satisfaction Questionnaire - Final Form	New
Form 762 2015 762 Final NCES Questionnaire 2016 Form and Instruction	New
Form 761 2015 761 USDA QAD - Customer Satisfaction Questionnaire - Final - 12.15.15 (2) Form and Instruction	New
Form 760 2015 760 OCS_CSBG_ACSI Survey of States Form and Instruction	New
Form 759 2015 759 Questionnaire Fogarty Webmonitor Form and Instruction	New
Form 758 2015 758 CMS OFM Provider Satisfaction Survey Form and Instruction	New
Form 757 2015 757 NIH NIAID Survey Form and Instruction	New
Form 754 2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2015 756 VBA Insurance Overall Questionnaire Form and Instruction	New
Form 753 2015 753 UDSA ACSI Webmoniter Survey Form and Instruction	New
Form 752 2015 752 OCS_CSGB_ACSI Survey of Eligible Entitities Form and Instruction	New
Form 751 2015 751 AFI_Grantee Satisfaction Survey Instrument Form and Instruction	New
Form 750 2015 750 VHA SB Survey Form and Instruction	New
Form 749 2015 749 AMS MN Customer Satisfaction Survey Form and Instruction	New
Form 748 DOJ COPS Questionnaire Form and Instruction	New
Form 747 DOJ JAG Questionnaire Form and Instruction	New
Form 746 FinCEN SAR Activity Review Form and Instruction	New
Form 745 NCA Customer Satisfaction Survey Form and Instruction	New
Form 744 CMS Contractor Survey Form and Instruction	New
Form 743 HRSA MCHB Form and Instruction	New
Form 742 VHA Champ Questionnaire Form and Instruction	New
Form 741 ED NCES Survey Form and Instruction	New
Form 740 RRB Rail Employers Survey Form and Instruction	New
Form 739 USDA NASS Customer Satisfaction Survey Form and Instruction	New
Form 738 VHA Inpatient Survey Form and Instruction	New
Form 737 VHA Outpatient Survey Form and Instruction	New
Form 736 NASA Lance Questionnaire Form and Instruction	New
Form 735 E-Verify Customer Satisfaction Survey Form and Instruction	New
Form 734 USDA Forest Service R&D Satisfaction Survey Form and Instruction	New
Form 733 State Passport Services Survey Form and Instruction	New
Form 732 NOAA NWS General Form and Instruction	New
Form 731 NASA EOSDIS Questionnaire Form and Instruction	New
Form 730 HRSA BPHC Health Care Program Form and Instruction	New
Form 729 USDA FSIS Call Center Form and Instruction	New
Form 728 U.S. Mint Call Center Questionnaire Form and Instruction	New
Form 727 SEC OIEA IVR Questionnaire Form and Instruction	New
Form 726 SEC OIEA Email Survey Form and Instruction	New
Form 725 Recreation Customer Service Survey Form and Instruction	New
Form 724 FTC Questionnaire Form and Instruction	New
Form 723 Dept. of ED Call Center Form and Instruction	New
Form 722 E-Verify Customer Contact Center Form and Instruction	New
Form 721 NWS Internet Panel Form and Instruction	New
Form 720 FEMA Local Officials Questionnaire Form and Instruction	New
Form 719 FinCEN Resource Center Customer Survey Form and Instruction	New
Form 718 Department of Ed Grantee Survey Form and Instruction	New
Form 717 SBA ODA Customer Satisfaction Survey Form and Instruction	New
Form 716 IRS LBI ACSI Questionnaire Form and Instruction	New
Form 715 IRS WI ACSI Questionaire Form and Instruction	New
Form 714 IRS SBE ACSI Questionnaire Form and Instruction	New
Form 713 PBGC Premium Filer Questionnaire Form and Instruction	New
Form 712 FAA Air Traffic Control Quarterly Survey Form and Instruction	New
Form 711 FinCEN Portal Query Survey Form and Instruction	New
Form 710 FinCEN Domestic Analytics Products Survey Form and Instruction	New
Form 709 FinCEN Foreign FIU Questionnaire Form and Instruction	New
Form 708 Nurse Corps Participant Survey Form and Instruction	New
Form 707 NHSC Participant Survey Form and Instruction	New
Form 706 HRSA HAB Grantee Questionniare Form and Instruction	New
Form 705 PBGC Participant Caller ACSI Survey Form and Instruction	New
Form 704 PBGC Retiree ACSI Instrument Form and Instruction	New
Form 703 FEMA BSB Printed Pubs Sat_Survey Form and Instruction	New
Form 702 FinCEN Compliance MOU Customer Survey Form and Instruction	New
Form 701 FinCEN BSA E-Filing Customer Survey Form and Instruction	New
Form 700 USDA Forest Service RD Questionnaire Form and Instruction	New
1090-0007 30 Day FRN 2015.pdf Supplementary Document	2015-03-18
2014 1090-0007 60 Day Notice.pdf Supplementary Document	2015-02-23
SS_for_1090-0007_Part_B_02.23.2015.doc Supporting Statement B	2015-02-23
SS_for_1090-0007_Part_A_02.23.2015.doc Supporting Statement A	2015-02-23
OVERVIEW OF THE ACSI BENCHMARK_3-5-13.doc Supplementary Document	2013-03-05
GUIDELINES PROVIDED TO AGENCIES.doc Supplementary Document	2013-02-20
E._O._13571_Streamlining_Service_Delivery_and_Improving_Customer_Service[1].doc Supplementary Document	2012-09-14
CFI_ACSI Methodology.pdf Supplementary Document	2009-08-14
ACSI Methodology Paper.pdf Supplementary Document	2009-08-13
CTA Comparison for OMB.pdf Supplementary Document	2009-08-10
E.O. 12,862.htm Supplementary Document	2009-08-05
E.O. 13,450.pdf Supplementary Document	2009-08-05
Government Performance Results Act of 1993.pdf Supplementary Document	2009-08-05

IC Document Collections

IC ID	Document Title	Status
232361	CMS PCG Customer Satisfaction Survey Form and Instruction	New
232336	SBA ODA Customer Service Survey Form and Instruction	New
232328	USDA Market News Form and Instruction	New
232256	Nurse Corps Participant Survey Form and Instruction	New
232250	NHSC Participant Survey Form and Instruction	New
232031	2018 014 WI ACSI Questionnaire Form and Instruction	New
232030	2018 013 SBSE ACSI Questionnaire Form and Instruction	New
232027	2018 012 LBI ACSI Questionnaire Form and Instruction	New
231929	2018 005 VA MOVE! Patient Experience Survey 2018_FINAL_3-23-18 -updated 6-22-18 Form and Instruction	New
231855	2018 011 Dept of ED CFO Grantee Questionnaire_to OMB_6.19.18 Form and Instruction	New
231580	NASA Earthdata Survey Form and Instruction	New
231337	FinCEN Regulatory Resource Center Survey Form and Instruction	New
231227	2018 007 Questionnaire_NPS.gov_Final Draft (1) Form and Instruction	New
231046	2018 006 Foreign FIU Survey_to OMB Form and Instruction	New
230646	2018 004 Retiree ACSI Instrument 2018 Form and Instruction	New
230237	2018 004 FinCEN BSA E-Filing Customer Survey 2018_FINAL Form and Instruction	New
230228	2018 003 FinCEN Portal_Query Survey FINAL Form and Instruction	New
230132	2018 002 FinCEN Compliance MOU Customer Survey 2018_FINAL_to OMB Form and Instruction	New
230011	2018 002 Products and Services_2018_FINAL Form and Instruction	New
229476	2017 838 USCIS Welcome Booklet Survey_to OMB 12-14 Form and Instruction	New
229235	2017 836 NPS CSP - Satisfaction Pilot Questionnaire Draft to FCG Form and Instruction	New
229234	2017 837 NCES Questionnaire 2017_to OMB Form and Instruction	New
229069	2017 835 PBGC Premium Filer Questionnaire 2018_FINAL to OMB Form and Instruction	New
228998	2017 834 B CA Call Center Survey 2017 v3.0 Spanish Form and Instruction	New
228908	2017 833 ACSI E-Verify Questionnaire 20171102 to OMB Form and Instruction	New
228749	2017 832 Benefits.gov - WebMonitor Questionniare - Final Form and Instruction	New
228729	2017 831 SBA survey v5.0 Form and Instruction	New
228655	2017 830 Spina Bifida Survey 2017 v2 Form and Instruction	New
228654	2017 829 CHAMPVA Survey 2017 v2 Form and Instruction	New
228633	2017 828 BCA Call Center Survey 2017 v3.1 Form and Instruction	New
228575	2017 826 VHA_Outpatient 2017 Survey to OMB Form and Instruction	New
228574	2017 827 VHA_Inpatient 2017 Survey to OMB Form and Instruction	New
228433	2017 825 OCS_CSBG_ACSI Survey of States_2017 Instrument_v2 to OMB Form and Instruction	New
228269	2017 824 FY18Q1_PopupSurvey_Clean_FINAL_091117_to OMB Form and Instruction	New
228107	2017 823 CSSurvey Questionnaire 2018_v4 Form and Instruction	New
228061	2017 822 Questionnaire_USGS Webmonitor_CFI Group Final_8.24.17 Form and Instruction	New
228060	2017 821 EOSDIS Questionnaire - Combined updated v2 clean Form and Instruction	New
228059	2017 820 ACSI Survey Questions_BCA Passport (Final Aug 16 2017) Form and Instruction	New
227944	2017 819 SBA ODA Customer Satisfaction Survey 2017_FINAL_20170815 Form and Instruction	New
227664	2017 818 NURSE Corps Participant Satisfaction Survey - Updated_20170718-CLEA... Form and Instruction	New
227663	2017 817 NHSC Site Satisfaction Survey - Updated_20170718-CLEAN Form and Instruction	New
227662	2017 816 NHSC Participant Satisfaction Survey - Updated_20170718-CLEAN Form and Instruction	New
227434	2017 815 BPHC 2017 Stakeholder Satisfaction Survey Questionnaire.v2 Form and Instruction	New
227433	2017 814 HRSA Grantee Satisfaction Survey - 6-16-17 Final Form and Instruction	New
227306	2017 813 FEMA HMA Survey Draft 6-20-17 V3.2 Form and Instruction	New
227286	2017 810 WI ACSI Questionnaire - 5.31 Form and Instruction	New
227285	2017 812 SBSE ACSI Questionnaire - 5.31 Form and Instruction	New
227284	2017 811 LBI ACSI Questionnaire -5.31 Form and Instruction	New
227039	2017 809 Resource Center Customer Survey_to OMB Form	New
226835	2017 804 FinCEN Domestic Analytic Products Survey_to OMB (1) Form and Instruction	New
226834	2017 805 FinCEN BSA E-Filing Customer Survey 2017_to OMB Form and Instruction	New
226833	2017 806 FinCEN Compliance MOU Customer Survey 2_1_16 to OMB Form and Instruction	New
226832	2017 807 FinCEN Portal_Query Survey_to OMB Form and Instruction	New
226831	2017 808 Foreign FIU Survey_to OMB Form and Instruction	New
226546	2017 803 Dept of ED CFO Grantee Questionnaire_to OMB Form and Instruction	New
226362	2017 802 E-Verify CCO Survey_2017 Proposed Revisions_20170315_c Form	New
226004	2017 801 MSI Questionnaire_CMS Final _Approved 3-3-17 Form and Instruction	New
225145	2016 800 PBGC Premium Filer Questionnaire 2017_FINAL Other-Survey	New
224711	2016 796 Questionaire _CRT_Webmonitor _CFI -Draft-1.5 Form	New
224710	2016 795 Questionnaire_climate.gov_CFI-Draft-1.3 Form	New
224669	2016 794 DOE_WAP_ACSI Survey of Local Agencies_2016 Form	New
224422	2016 793 NPS Contracting Office Customer Satisfaction Survey_Final to OMB Form and Instruction	New
224344	2016 793 DOI OST Beneficiaries Questionaire_Final Form and Instruction	New
223960	2016 792 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2016- OMB submission Form	New
223722	2016 791 ACSI E-Verify Questionnaire initial draft with USCIS CFI edits 20160510_NR changes accepted (1) Form	New
223721	2016 790 HRSA HAB Grantee Questionnaire - 2016 Final Edits for CFI RR Final Edits 9-26-16 OMB review Form	New
223603	2016 789 VHA_Outpatient 2016 Survey Form	New
223602	2016 788 VHA_Inpatient 2016 Survey Form	New
223601	2016 787 DOE_WAP_ACSI Survey of States_Grantees_2016 Questionnaire_Final Form	New
223273	2016 786 DOI OST Call Center Questionnaire - Final Form	New
223009	2016 785 EOSDIS Questionnaire Form	New
223008	2016 784 NASA LANCE Questionnaire Form	New
222668	2016 783 SBA ODA Customer Satisfaction Survey 2016_FINAL Form and Instruction	New
222598	2016 782 NHSC 2016 Participant Questionnaire _FINAL_20160721 Form and Instruction	New
222597	2016 781 NURSE Corps 2016 Participant Questionnaire_FINAL_20160721 Form	New
222427	2016 780 WI ACSI Questionnaire - 7.11.2016 Form and Instruction	New
222426	2016 779 SBSE ACSI Questionnaire - 7.11.2016 Form and Instruction	New
222425	2016 778 LBI ACSI Questionnaire - 7.11.2016 Form and Instruction	New
222383	2016 777 BCA Passport Survey FINAL_ to OMB Form and Instruction	New
222337	2016 776 BPHC 2016 Stakeholder Satisfaction Survey Questionnaire Final Form and Instruction	New
222082	2016 776 Resource Center Customer Survey_final_to OMB Form	New
221487	2016 775 FAA Website Questionnaire - Final - 5.6.16 Form and Instruction	New
221216	2016 775 Foreign FIU Survey_v1_clean Form	New
221215	2016 774 MSI Questionnaire Final 04062016 Form	New
221011	2015 773 FinCEN Portal_Query Survey_to OMB Form	New
221010	2015 772 FinCEN Domestic Analytic Products Survey to OMB Form	New
221008	2015 771 Dept of ED CFO Grantee Questionnaire CORE + ALL CUSTOM_Final Form	New
221005	2015 770 5ACSI E-Verify Questionnaire for OBM clearance Form	New
220650	2015 769 FinCEN BSA E-Filing Customer Survey 2016_to OMB Form	New
220649	2015 768 FEMA - BSB Printed Pubs Sat Survey_v0_20151124 Form	New
220648	2015 767 HRSA Grantee Satisfaction Survey_for CFI FCG v2 Form	New
220611	2015 766 GSA WebMonitor Questionnaire - Final Form	New
220319	2015 765 FinCEN Compliance MOU Customer Survey 2_25_16 Form	New
220317	2015 764 NCA_Questionnaire_2016 (same as last year) Form	New
220316	2015 764 NCA_Questionnaire_2016 (same as last year) Form	New
220315	2015 763 USDA New Farmers Program - Customer Satisfaction Questionnaire - Final Form	New
219291	2015 762 Final NCES Questionnaire 2016 Form and Instruction	New
219289	2015 761 USDA QAD - Customer Satisfaction Questionnaire - Final - 12.15.15 (2) Form and Instruction	New
218754	2015 760 OCS_CSBG_ACSI Survey of States Form and Instruction	New
218703	2015 759 Questionnaire Fogarty Webmonitor Form and Instruction	New
218493	2015 758 CMS OFM Provider Satisfaction Survey Form and Instruction	New
218348	2015 757 NIH NIAID Survey Form and Instruction	New
218255	2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2015 756 VBA Insurance Overall Questionnaire Form and Instruction	New
218046	2015 753 UDSA ACSI Webmoniter Survey Form and Instruction	New
218022	2015 752 OCS_CSGB_ACSI Survey of Eligible Entitities Form and Instruction	New
217307	2015 751 AFI_Grantee Satisfaction Survey Instrument Form and Instruction	New
216688	2015 750 VHA SB Survey Form and Instruction	New
216637	2015 749 AMS MN Customer Satisfaction Survey Form and Instruction	New
215360	DOJ COPS Questionnaire Form and Instruction	New
215359	DOJ JAG Questionnaire Form and Instruction	New
215358	FinCEN SAR Activity Review Form and Instruction	New
215356	NCA Customer Satisfaction Survey Form and Instruction	New
215341	CMS Contractor Survey Form and Instruction	New
215334	HRSA MCHB Form and Instruction	New
215332	VHA Champ Questionnaire Form and Instruction	New
215331	ED NCES Survey Form and Instruction	New
215316	RRB Rail Employers Survey Form and Instruction	New
215311	USDA NASS Customer Satisfaction Survey Form and Instruction	New
215309	VHA Inpatient Survey Form and Instruction	New
215307	VHA Outpatient Survey Form and Instruction	New
215306	NASA Lance Questionnaire Form and Instruction	New
215305	E-Verify Customer Satisfaction Survey Form and Instruction	New
215303	USDA Forest Service R&D Satisfaction Survey Form and Instruction	New
215299	State Passport Services Survey Form and Instruction	New
215294	NOAA NWS General Form and Instruction	New
215291	NASA EOSDIS Questionnaire Form and Instruction	New
215285	HRSA BPHC Health Care Program Form and Instruction	New
215284	USDA FSIS Call Center Form and Instruction	New
215282	U.S. Mint Call Center Questionnaire Form and Instruction	New
215281	SEC OIEA IVR Questionnaire Form and Instruction	New
215280	SEC OIEA Email Survey Form and Instruction	New
215279	Recreation Customer Service Survey Form and Instruction	New
215278	FTC Questionnaire Form and Instruction	New
215277	Dept. of ED Call Center Form and Instruction	New
215276	E-Verify Customer Contact Center Form and Instruction	New
215275	NWS Internet Panel Form and Instruction	New
215274	FEMA Local Officials Questionnaire Form and Instruction	New
215273	FinCEN Resource Center Customer Survey Form and Instruction	New
215272	Department of Ed Grantee Survey Form and Instruction	New
215271	SBA ODA Customer Satisfaction Survey Form and Instruction	New
215270	IRS LBI ACSI Questionnaire Form and Instruction	New
215269	IRS WI ACSI Questionaire Form and Instruction	New
215267	IRS SBE ACSI Questionnaire Form and Instruction	New
215266	PBGC Premium Filer Questionnaire Form and Instruction	New
215207	FAA Air Traffic Control Quarterly Survey Form and Instruction	New
215206	FinCEN Portal Query Survey Form and Instruction	New
215205	FinCEN Domestic Analytics Products Survey Form and Instruction	New
215204	FinCEN Foreign FIU Questionnaire Form and Instruction	New
215203	Nurse Corps Participant Survey Form and Instruction	New
215202	NHSC Participant Survey Form and Instruction	New
215200	HRSA HAB Grantee Questionniare Form and Instruction	New
215199	PBGC Participant Caller ACSI Survey Form and Instruction	New
215191	PBGC Retiree ACSI Instrument Form and Instruction	New
215189	FEMA BSB Printed Pubs Sat_Survey Form and Instruction	New
215188	FinCEN Compliance MOU Customer Survey Form and Instruction	New
215187	FinCEN BSA E-Filing Customer Survey Form and Instruction	New
215186	USDA Forest Service RD Questionnaire Form and Instruction	New

ICR Details

OMB Control No: 1090-0007	ICR Reference No: 201412-1090-003
Status: Historical Active	Previous ICR Reference No: 201209-1090-001
Agency/Subagency: DOI/ASPMB	Agency Tracking No: 1090-0007
Title: American Customer Satisfaction Index "Customer Satisfaction Surveys"
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/13/2015
	Date Received in OIRA: 03/18/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	240,000	0	131,250
Time Burden (Hours)	48,000	0	26,250
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request for a a three-year extension of the generic clearance to conduct customer satisfaction measures of Federal Government programs and services utilizing the methodology of the American Customer Satisfaction Index (ACSI). This extension will allow for continued use of a data-driven, statistically valid approach to understanding customer satisfaction with agency interactions and processes. By using the ACSI methodology, agencies gain important insights about who their customers are and what specifically drives their satisfaction. This allows decision-makers to objectively measure their processes and/or service delivery and use the results to allocate resources more effectively. The ultimate objective is to help agencies become more citizen-centric and achieve higher levels of citizen trust and confidence.

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Authorizing Statute(s): EO: EO 13450 Name/Subject of EO: Improving Government Program Performance
   EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
   EO: EO 13571 Name/Subject of EO: Streamlining Service Delivery and Improving Customer Service
   US Code: 31 USC 1116 Name of Law: Government Performance Results Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 68689	11/18/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 14152	03/18/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 157

IC Title	Form No.	Form Name
2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2015 756 VBA Insurance Overall Questionnaire	755, 754, 756	2015 754 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire ,   2015 755 HRSA HAB - ART Survey ,   2015 756 VBA Insurance Overall Questionnaire
E-Verify Customer Contact Center	722	Customer Contact Center Survey E-Verify
Department of Ed Grantee Survey	718	Dept of ED CFO Grantee Questionnaire
FinCEN BSA E-Filing Customer Survey	701	FinCEN BSA E-Filing Customer Survey
FinCEN Compliance MOU Customer Survey	702	FinCEN Compliance MOU Customer Survey
HRSA MCHB	743	HRSA MCHB
NCA Customer Satisfaction Survey	745	NCA Customer Satisfaction Mail Survey
USDA Forest Service R&D Satisfaction Survey	734	USDA Forest Service RD Customer Satisfaction Questionnaire
VHA Inpatient Survey	738	VHAInpatient Survey
2015 762 Final NCES Questionnaire 2016	762	2015 762 Final NCES Questionnaire 2016
2017 807 FinCEN Portal_Query Survey_to OMB	807	2017 807 FinCEN Portal_Query Survey_to OMB
2017 805 FinCEN BSA E-Filing Customer Survey 2017_to OMB	805	2017 805 FinCEN BSA E-Filing Customer Survey 2017_to OMB
2017 820 ACSI Survey Questions_BCA Passport (Final Aug 16 2017)	820	2017 820 ACSI Survey Questions_BCA Passport (Final Aug 16 2017)
2017 811 LBI ACSI Questionnaire -5.31	811	2017 811 LBI ACSI Questionnaire -5.31
2016 781 NURSE Corps 2016 Participant Questionnaire_FINAL_20160721	781	2016 781 NURSE Corps 2016 Participant Questionnaire_FINAL_20160721
2016 783 SBA ODA Customer Satisfaction Survey 2016_FINAL	783	2016 783 SBA ODA Customer Satisfaction Survey 2016_FINAL
2017 829 CHAMPVA Survey 2017 v2	829	2017 829 CHAMPVA Survey 2017 v2
2016 792 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2016- OMB submission	792	2016 792 HRSA HAB CAREWare Customer Satisfaction and User Questionnaire - 2016- OMB submission
CMS Contractor Survey	744	CMS MAC Questionnaire
U.S. Mint Call Center Questionnaire	728	US Mint Call Center Questionnaire
PBGC Retiree ACSI Instrument	704	PBGC Retiree ACSI Instrument
PBGC Participant Caller ACSI Survey	705	PBGC Participant Caller ACSI Instrument
PBGC Premium Filer Questionnaire	713	PBGC Premium Filer Questionnaire
2015 752 OCS_CSGB_ACSI Survey of Eligible Entitities	752	2015 752 OCS_CSBG_ACSI Survey of Eligible Entitites
2016 778 LBI ACSI Questionnaire - 7.11.2016	778	2016 778 LBI ACSI Questionnaire - 7.11.2016
2016 779 SBSE ACSI Questionnaire - 7.11.2016	779	2016 779 SBSE ACSI Questionnaire - 7.11.2016
2016 776 BPHC 2016 Stakeholder Satisfaction Survey Questionnaire Final	776	2016 776 BPHC 2016 Stakeholder Satisfaction Survey Questionnaire Final
State Passport Services Survey	733	State Passport Services Survey
VHA Outpatient Survey	737	VHA Outpatient
2015 757 NIH NIAID Survey	757	2015 757 NIH NIAID Survey
2015 763 USDA New Farmers Program - Customer Satisfaction Questionnaire - Final	763	2015 763 USDA New Farmers Program - Customer Satisfaction Questionnaire - Final
2015 765 FinCEN Compliance MOU Customer Survey 2_25_16	765	2015 765 FinCEN Compliance MOU Customer Survey 2_25_16
2015 769 FinCEN BSA E-Filing Customer Survey 2016_to OMB	769	2015 769 FinCEN BSA E-Filing Customer Survey 2016_to OMB
2015 773 FinCEN Portal_Query Survey_to OMB	773	2015 773 FinCEN Portal_Query Survey_to OMB
2017 836 NPS CSP - Satisfaction Pilot Questionnaire Draft to FCG	836	2017 836 NPS CSP - Satisfaction Pilot Questionnaire Draft to FCG
2017 837 NCES Questionnaire 2017_to OMB	837	2017 837 NCES Questionnaire 2017_to OMB
2017 806 FinCEN Compliance MOU Customer Survey 2_1_16 to OMB	806	2017 806 FinCEN Compliance MOU Customer Survey 2_1_16 to OMB
2017 808 Foreign FIU Survey_to OMB	808	2017 808 Foreign FIU Survey_to OMB
2017 803 Dept of ED CFO Grantee Questionnaire_to OMB	803	2017 803 Dept of ED CFO Grantee Questionnaire_to OMB
2017 809 Resource Center Customer Survey_to OMB	809	2017 809 Resource Center Customer Survey_to OMB
2017 819 SBA ODA Customer Satisfaction Survey 2017_FINAL_20170815	819	2017 819 SBA ODA Customer Satisfaction Survey 2017_FINAL_20170815
2017 816 NHSC Participant Satisfaction Survey - Updated_20170718-CLEAN	816	2017 816 NHSC Participant Satisfaction Survey - Updated_20170718-CLEAN
2016 787 DOE_WAP_ACSI Survey of States_Grantees_2016 Questionnaire_Final	787	2016 787 DOE_WAP_ACSI Survey of States_Grantees_2016 Questionnaire_Final
2018 013 SBSE ACSI Questionnaire	013	2018 013 SBSE ACSI Questionnaire
2018 004 Retiree ACSI Instrument 2018	004	2018 004 Retiree ACSI Instrument 2018
Nurse Corps Participant Survey	016	Nurse Corps Participant Survey
2015 760 OCS_CSBG_ACSI Survey of States	760	2015 760 OCS_CSBG_ACSI Survey of States
ED NCES Survey	741	NCES Questionnaire
FEMA BSB Printed Pubs Sat_Survey	703	2015 FEMA - BSB Printed Pubs Sat Survey
HRSA HAB Grantee Questionniare	706	HRSA HAB Grantee Questionnaire
2015 772 FinCEN Domestic Analytic Products Survey to OMB	772	2015 772 FinCEN Domestic Analytic Products Survey to OMB
2016 777 BCA Passport Survey FINAL_ to OMB	777	2016 777 BCA Passport Survey FINAL_ to OMB
NASA Lance Questionnaire	736	NASA LANCe Questionnaire
2017 835 PBGC Premium Filer Questionnaire 2018_FINAL to OMB	835	2017 835 PBGC Premium Filer Questionnaire 2018_FINAL to OMB
2016 784 NASA LANCE Questionnaire	784	2016 784 NASA LANCE Questionnaire
2016 785 EOSDIS Questionnaire	785	2016 785 EOSDIS Questionnaire
2016 800 PBGC Premium Filer Questionnaire 2017_FINAL
2016 782 NHSC 2016 Participant Questionnaire _FINAL_20160721	782	2016 782 NHSC 2016 Participant Questionnaire _FINAL_20160721
2017 822 Questionnaire_USGS Webmonitor_CFI Group Final_8.24.17	822	2017 822 Questionnaire_USGS Webmonitor_CFI Group Final_8.24.17
2017 838 USCIS Welcome Booklet Survey_to OMB 12-14	838	2017 838 USCIS Welcome Booklet Survey_to OMB 12-14
2018 012 LBI ACSI Questionnaire	007	2018 012 LBI ACSI Questionnaire
2018 002 Products and Services_2018_FINAL	002	2018 002 Products and Services_2018_FINAL
2018 002 FinCEN Compliance MOU Customer Survey 2018_FINAL_to OMB	002	2018 002 FinCEN Compliance MOU Customer Survey 2018_FINAL_to OMB
2018 006 Foreign FIU Survey_to OMB	006	2018 006 Foreign FIU Survey_to OMB
Dept. of ED Call Center	723	Dept of ED Call Center Questionnaire
FTC Questionnaire	724	FTC Questionnaire
USDA FSIS Call Center	729	USDA FSIS Call Center Questionnaire
IRS LBI ACSI Questionnaire	716	IRS LBI ACSI Questionnaire
IRS SBE ACSI Questionnaire	714	IRS SBSE ACSI Questionnaire
SBA ODA Customer Satisfaction Survey	717	SBA ODA Customer Satisfaction Survey
FinCEN Resource Center Customer Survey	719	FinCEN Resource Center Customer Survey
USDA Forest Service RD Questionnaire	700	USDA Forest Service RD Customer Satisfaction Questionnaire
HRSA BPHC Health Care Program	730	HRSA BPHC Health Center Program Survey
NASA EOSDIS Questionnaire	731	EOSDIS Questionnaire
USDA NASS Customer Satisfaction Survey	739	NASS Customer Satisfaction Survey
RRB Rail Employers Survey	740	RRB Rail Employers Survey
2015 771 Dept of ED CFO Grantee Questionnaire CORE + ALL CUSTOM_Final	771	2015 771 Dept of ED CFO Grantee Questionnaire CORE + ALL CUSTOM_Final
2017 804 FinCEN Domestic Analytic Products Survey_to OMB (1)	804	2017 804 FinCEN Domestic Analytic Products Survey_to OMB (1)
2016 793 NPS Contracting Office Customer Satisfaction Survey_Final to OMB	793	2016 793 NPS Contracting Office Customer Satisfaction Survey_Final to OMB
2016 794 DOE_WAP_ACSI Survey of Local Agencies_2016	794	2016 794 DOE_WAP_ACSI Survey of Local Agencies_2016
2016 793 DOI OST Beneficiaries Questionaire_Final	793	2016 793 DOI OST Beneficiaries Questionaire_Final
2017 802 E-Verify CCO Survey_2017 Proposed Revisions_20170315_c	802	2017 802 E-Verify CCO Survey_2017 Proposed Revisions_20170315_c
2017 801 MSI Questionnaire_CMS Final _Approved 3-3-17	801	2017 801 MSI Questionnaire_CMS Final _Approved 3-3-17
2017 812 SBSE ACSI Questionnaire - 5.31	812	2017 812 SBSE ACSI Questionnaire - 5.31
FinCEN Regulatory Resource Center Survey	008	FinCEN Regulatory Resource Center Survey
2018 011 Dept of ED CFO Grantee Questionnaire_to OMB_6.19.18	011	2018 011 Dept of ED CFO Grantee Questionnaire_to OMB_6.19.18
DOJ JAG Questionnaire	747	DOJ JAG Questionnaire
Recreation Customer Service Survey	725	Recreation Customer Service Survey
FEMA Local Officials Questionnaire	720	FEMA Local Officials Questionnaire
Nurse Corps Participant Survey	708	NURSE Corps Participant Questionnaire
2015 753 UDSA ACSI Webmoniter Survey	753	2015 753 USDA ACSI Web Monitor Survey
2016 780 WI ACSI Questionnaire - 7.11.2016	780	2016 780 WI ACSI Questionnaire - 7.11.2016
2015 766 GSA WebMonitor Questionnaire - Final	766	2015 766 GSA WebMonitor Questionnaire - Final
2015 764 NCA_Questionnaire_2016 (same as last year)	764	2015 764 NCA_Questionnaire_2016 (same as last year)
2015 770 5ACSI E-Verify Questionnaire for OBM clearance	770	2015 770 5ACSI E-Verify Questionnaire for OBM clearance
2017 814 HRSA Grantee Satisfaction Survey - 6-16-17 Final	814	2017 814 HRSA Grantee Satisfaction Survey - 6-16-17 Final
2017 815 BPHC 2017 Stakeholder Satisfaction Survey Questionnaire.v2	815	2017 815 BPHC 2017 Stakeholder Satisfaction Survey Questionnaire.v2
2017 826 VHA_Outpatient 2017 Survey to OMB	826	2017 826 VHA_Outpatient 2017 Survey to OMB
2017 832 Benefits.gov - WebMonitor Questionniare - Final	832	2017 832 Benefits.gov - WebMonitor Questionniare - Final
2017 817 NHSC Site Satisfaction Survey - Updated_20170718-CLEAN	817	2017 817 NHSC Site Satisfaction Survey - Updated_20170718-CLEAN
CMS PCG Customer Satisfaction Survey	019	CMS PCG Customer Satisfaction Survey
2018 003 FinCEN Portal_Query Survey FINAL	003	2018 003 FinCEN Portal_Query Survey FINAL
2018 004 FinCEN BSA E-Filing Customer Survey 2018_FINAL	004	2018 004 FinCEN BSA E-Filing Customer Survey 2018_FINAL
NASA Earthdata Survey	007	NASA Earthdata Survey
2018 014 WI ACSI Questionnaire	014	2018 014 WI ACSI Questionnaire
NHSC Participant Survey	015	NHSC Participant Survey
2015 750 VHA SB Survey	750	2015 750 VHA SB Survey
IRS WI ACSI Questionaire	715	IRS WI ACSI Questionnaire
FinCEN Domestic Analytics Products Survey	710	Domestic Analytics Products Survey
NHSC Participant Survey	707	NHSC Participant Questionnaire
FinCEN Foreign FIU Questionnaire	709	Foreign FIU Survey
FinCEN Portal Query Survey	711	FinCEN Portal Query Survey
FAA Air Traffic Control Quarterly Survey	712	FAA Air Traffic Control Organization FSS Quarterly
FinCEN SAR Activity Review	746	SAR Activity Review
2016 775 FAA Website Questionnaire - Final - 5.6.16	775	2016 775 FAA Website Questionnaire - Final - 5.6.16
2016 776 Resource Center Customer Survey_final_to OMB	776	2016 776 Resource Center Customer Survey_final_to OMB
2015 764 NCA_Questionnaire_2016 (same as last year)	764	2015 764 NCA_Questionnaire_2016 (same as last year)
2015 767 HRSA Grantee Satisfaction Survey_for CFI FCG v2	767	2015 767 HRSA Grantee Satisfaction Survey_for CFI FCG v2
2015 768 FEMA - BSB Printed Pubs Sat Survey_v0_20151124	768	2015 768 FEMA - BSB Printed Pubs Sat Survey_v0_20151124
2016 775 Foreign FIU Survey_v1_clean	775	2016 775 Foreign FIU Survey_v1_clean
2016 791 ACSI E-Verify Questionnaire initial draft with USCIS CFI edits 20160510_NR changes accepted (1)	791	2016 791 ACSI E-Verify Questionnaire initial draft with USCIS CFI edits 20160510_NR changes accepted (1)
2016 796 Questionaire _CRT_Webmonitor _CFI -Draft-1.5	796	2016 796 Questionaire _CRT_Webmonitor _CFI -Draft-1.5
2017 827 VHA_Inpatient 2017 Survey to OMB	827	2017 827 VHA_Inpatient 2017 Survey to OMB
2017 818 NURSE Corps Participant Satisfaction Survey - Updated_20170718-CLEA...	818	2017 818 NURSE Corps Participant Satisfaction Survey - Updated_20170718-CLEA...
2018 007 Questionnaire_NPS.gov_Final Draft (1)	007	2018 007 Questionnaire_NPS.gov_Final Draft (1)
2018 005 VA MOVE! Patient Experience Survey 2018_FINAL_3-23-18 -updated 6-22-18	005	2018 005 VA MOVE! Patient Experience Survey 2018_FINAL_3-23-18 -updated 6-22-18
2015 751 AFI_Grantee Satisfaction Survey Instrument	751	2015 751 AFI Grantee Satisfaction Survey Instrument
2015 758 CMS OFM Provider Satisfaction Survey	758	2015 CMS OFM Provider Satisfaction Survey
NWS Internet Panel	721	NWS InternetPanel DCY SR
SEC OIEA Email Survey	726	SEC OIEA Questionnaire Email
2016 790 HRSA HAB Grantee Questionnaire - 2016 Final Edits for CFI RR Final Edits 9-26-16 OMB review	790	2016 790 HRSA HAB Grantee Questionnaire - 2016 Final Edits for CFI RR Final Edits 9-26-16 OMB review
2016 795 Questionnaire_climate.gov_CFI-Draft-1.3	795	2016 795 Questionnaire_climate.gov_CFI-Draft-1.3
2016 786 DOI OST Call Center Questionnaire - Final	786	2016 786 DOI OST Call Center Questionnaire - Final
2017 824 FY18Q1_PopupSurvey_Clean_FINAL_091117_to OMB	824	2017 824 FY18Q1_PopupSurvey_Clean_FINAL_091117_to OMB
2017 825 OCS_CSBG_ACSI Survey of States_2017 Instrument_v2 to OMB	825	2017 825 OCS_CSBG_ACSI Survey of States_2017 Instrument_v2 to OMB
2016 788 VHA_Inpatient 2016 Survey	788	2016 788 VHA_Inpatient 2016 Survey
USDA Market News	017	USDA Market News
2015 759 Questionnaire Fogarty Webmonitor	759	2015 759 Questionnaire - Fogarty Webmonitor
VHA Champ Questionnaire	742	ACSI CHAMPVA
SEC OIEA IVR Questionnaire	727	SEC OIEA Questionnaire IVR
DOJ COPS Questionnaire	748	DOJ COPS Annual Survey
NOAA NWS General	732	NWS General
E-Verify Customer Satisfaction Survey	735	E-Verification Customer Satisfaction Survey
2015 749 AMS MN Customer Satisfaction Survey	749	2015 AMS MN Customer Satisfaction Survey
2015 761 USDA QAD - Customer Satisfaction Questionnaire - Final - 12.15.15 (2)	761	2015 761 USDA QAD - Customer Satisfaction Questionnaire - Final - 12.15.15 (2)
2016 774 MSI Questionnaire Final 04062016	774	2016 774 MSI Questionnaire Final 04062016
2017 828 BCA Call Center Survey 2017 v3.1	828	2017 828 BCA Call Center Survey 2017 v3.1
2017 833 ACSI E-Verify Questionnaire 20171102 to OMB	833	2017 833 ACSI E-Verify Questionnaire 20171102 to OMB
2017 831 SBA survey v5.0	831	2017 831 SBA survey v5.0
2017 810 WI ACSI Questionnaire - 5.31	810	2017 810 WI ACSI Questionnaire - 5.31
2017 813 FEMA HMA Survey Draft 6-20-17 V3.2	813	2017 813 FEMA HMA Survey Draft 6-20-17 V3.2
2017 821 EOSDIS Questionnaire - Combined updated v2 clean	821	2017 821 EOSDIS Questionnaire - Combined updated v2 clean
2017 830 Spina Bifida Survey 2017 v2	830	2017 830 Spina Bifida Survey 2017 v2
2017 834 B CA Call Center Survey 2017 v3.0 Spanish	834	2017 834 B CA Call Center Survey 2017 v3.0 Spanish
2017 823 CSSurvey Questionnaire 2018_v4	823	2017 823 CSSurvey Questionnaire 2018_v4
2016 789 VHA_Outpatient 2016 Survey	789	2016 789 VHA_Outpatient 2016 Survey
SBA ODA Customer Service Survey	018	SBA ODA Customer Satisfaction Survey

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	240,000	131,250	0	0	108,750	0
Annual Time Burden (Hours)	48,000	26,250	0	0	21,750	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $4,014,332

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/18/2015

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