Information Collection

Portland Area Division of Environment Health Services: Customer Service Assessment.

IC 216470 under ICR 201504-0917-007 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0036 Portland Area Division of Environment Health Services: Customer Service Assessment. Portland Area Division of Environment Health Services: Customer Service Assessment.	Form and Instruction
0917-0036 Portland Area Division of Environment Health Services: C OMB No 0917-0036-21 Portland Area Division of Environmental Health Services Customer Services Assessment.pdf	Form and Instruction
OMB No 0917-0036-21 Mini Supporting Statement for Portland Area DEHS Customer 5-7-13.pdf OMB No. 0917-0036, Mini-Supporting Statement for Portland Area Division of Environment Health Services: Customer Service Assessm	IC Document

IC Title:

Portland Area Division of Environment Health Services: Customer Service Assessment.

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	0917-0036	Portland Area Division of Environment Health Services: Customer Service Assessment.	OMB No 0917-0036-21 Portland Area Division of Environmental Health Services Customer Services Assessment.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB No. 0917-0036, Mini-Supporting Statement for Portland Area Division of Environment Health Services: Customer Service Assessment.	OMB No 0917-0036-21 Mini Supporting Statement for Portland Area DEHS Customer 5-7-13.pdf	05/07/2015

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