BIA TCRP Program

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

2 Provide Feedback to BIA Tribal Climate Change Program

BIA TCRP Program

OMB: 1090-0011

Document [pdf]
Download: pdf | pdf
4/17/2017

Provide Feedback to BIA Tribal Climate Change Program

Edit this form

Provide Feedback to BIA Tribal Climate Change
Program
Feedback Form Accessed from BIA TCRP Homepage: 
https://www.indianaffairs.gov/WhoWeAre/BIA/climatechange/index.htm
PERSONAL INFORMATION PROTECTION adapted from DOI Privacy Policy at 
https://www.doi.gov/privacy:
You do not have to provide personal information to provide feedback.  If you choose to provide personal 
information, such as by sending an e­mail or phone number through this feedback form in order to provide 
you a personal response back, we will use the information you provide to respond to you and then delete 
it.  If you prefer not to provide email or phone or name as personal information in the form below, call 
Margaret directly at 720­484­3353 or email [email protected]
Please do not send us sensitive information, such as your credit card or social security numbers, via e­
mail. It is possible that during transmission of your e­mail this information may be intercepted by a third 
party. We cannot guarantee its safety while in transit.
We use personally identifiable information to further our customer's protection and to provide better 
service. This may be to correct broken links that you have identified or provide additional information that 
you have requested.
Any information that we collect may be subject to disclosure, but will be handled in accordance with the 
requirements of the Privacy Act and the Freedom of Information Act to ensure the greatest protection of 
personal privacy.
* Required

Feedback Category *
Please enter the main type of feedback
 
This is a required question
Details *
Please provide your detailed feedback

If you'd like a direct response, please include your Name
If you need a response to your feedback, please provide your name
https://docs.google.com/a/bia.gov/forms/d/e/1FAIpQLSfOVi5XbvEV3Rf347wydeC8HF9mGfHvlRNGDT_bftgJdFx3dw/viewform

1/2

4/17/2017

Provide Feedback to BIA Tribal Climate Change Program

and either an email or phone
If you need a response to your feedback, also add a 10-digit U.S. phone number or email

Submit

Never submit passwords through Google Forms.

Powered by

This form was created inside of DEPARTMENT OF THE INTERIOR.  
Report Abuse ­ Terms of Service ­ Additional Terms

https://docs.google.com/a/bia.gov/forms/d/e/1FAIpQLSfOVi5XbvEV3Rf347wydeC8HF9mGfHvlRNGDT_bftgJdFx3dw/viewform

2/2


File Typeapplication/pdf
File Modified2017-04-17
File Created2017-04-17

© 2024 OMB.report | Privacy Policy