Information Collection

ORO-Dallas Virtual Participant Satisfaction Survey

IC 220987 under ICR 201502-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 ORO-Dallas Virtual Participant Satisfaction Survey	Form and Instruction
1 ORO Dallas Virtual Participant Satisfaction Survey ORO Dallas Virtual Participant Satisfaction Survey-1.docx	Form and Instruction
Justification - Survey Generic Clearance.docx Draft 1.docx Supporting Statment	IC Document

IC Title:

ORO-Dallas Virtual Participant 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 and Instruction	1	ORO Dallas Virtual Participant Satisfaction Survey	ORO Dallas Virtual Participant Satisfaction Survey-1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 275

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	275	275
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statment	Justification - Survey Generic Clearance.docx Draft 1.docx	04/08/2016

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